Managed Care Lead

Long Beach, CA 90802

Job Number: 2669

Job Description

Managed Care Lead

Job Description
 
Purpose: The Managed Care Lead will work under the direction of the Medical Collections Manager.  The lead is responsible to assist and support the Collections Manager in the day-to-day operations and back up the staff.  The Managed Care Lead will perform quality assurance audits and contribute feedback to management in overall employee work performance and ensure adequate staffing coverage.  They will assist the Manager in training new personnel on our computer system and orientating them to the systems we utilize for recoveries. The lead will also maintain regular job duties as a collection analyst dependent on the business needs of the department. Essential Job Functions:
Complete the following functions in accordance with Managed Resources policies:
  • Answers staff day to day questions
  • Assists staff and management to research problem issues and/or patient accounts and payer contracts.
  • Responsible for keeping staff informed of all changes in policy & procedures and/or payer updates.
  • Train new employees and review new employee’ s daily work.
  • Train new processes with current staff as needed.
  • Ability to back up the analyst during staff shortages and/or special projects as needed.
  • Coordinate PI list to the appropriate parties to obtain and elevate unresolved PI requests.
  • Ability to interact with co-workers, payers, clients, and management in a professional manner.
  • Promote teamwork and motivates staff to obtain monthly goals.
  • Keeps management informed of daily issues and/or potential problems.
  • Recommend ideas to streamline workflow and promote efficiency and reduce cost.
  • Review employee daily work as needed
  • Back up for client adjustments
  • Maintain job duties as a collection analyst dependent on the business needs of the department.
  • Develops and maintains strong working relationships with other leaders and provides cross coverage as needed.
  • Provides feedback to Manager and Director on operational concerns and oversight of team members.
  • Exemplifies the core values of Managed Resources.
  • Assist with special projects and other duties as assigned.

Education and Experience:
  • 1 Year experience as managed care analyst / auditor
  • Minimum of high school diploma.  Some college is desired
Ideal candidate will possess:
  • Ability to work with general supervision to perform tasks assigned effectively and on a timely basis
  • Proficient in the basics of Microsoft Word and Excel
  • Ability to interpret payer contract terms (DRG, per diem, case rate, stop loss, etc.)
  • Be familiar with UB04 claim form
  • Verbal communications skills sufficient to interact efficiently and effectively with co-workers and external parties including payers, patients, clients, etc.
  • Billing and/or coding experience is desirable.
  • Written communication skills sufficient to generate letters, emails, and/or memorandums to payers in order to explain situations, document problems, and/or agreements, etc.
  • Ability to learn computer applications used by external clients (hospitals)
  • Ability to work independently in a fast-paced environment.
  • Possess strong organizational skills and attention to detail.
  • Ability to multi-task and meet multiple deadlines.
  • Proven leadership skills including ability to provide necessary oversight to team members.
  Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

 

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