MCO Recertification Specialist
Description:Account Management/ formerly MCO (Managed Care) Recertification Department: Billing/Collections Specialist
Reviews, analyzes, and reconciles initial Accounts Receivable and Order Entry exceptions and discrepancies to ensure accurate invoicing and prompt payment within business practice and time sensitive guidelines.
Performs extended resolution activities on more extensive exceptions and discrepancies including engaging parties such as Finance Department, National Contact Center, Contracts Area andI field staff to collect necessary transaction details required to advance the resolution process. Utilizes higher-level knowledge of accounts receivable practices and information systems to identify and remove barriers to account collection.
Facilitates high volume, extensive professional level verbal and written communications to a broad spectrum of internal and external contacts during all resolution activities operating within strict federal credit guidelines and in full compliance with Sarbanes-Oxley regulatory requirements.
Researches and verifies all requisite specific transactional information such as contractual stipulations and service dates, initial order entry information, purchase order information, contract information such as price breaks, volume commitment levels, current and actual volume levels.
Practices continual autonomous decision-making based on knowledge and understanding of a variety of contractual pricing structures. Facilitates independent actions to assure purchasing and activities are within stated contractual guidelines including recognizing and complying with various dynamic and goodwill pricing structures.
Prioritize and execute based on customer and/or business urgency
Verify third party payer benefits and eligibility (online or telephone)
Initiate prior authorization/pre-certification with third party payers (online/telephone)
Ability to review clinical notes and determining the best fit diagnosis code for accurate billing
Call customers or field personnel to obtain missing documentation required for billing. Could include home health agencies, patients, hospitals/facilities, physicians
Conforms to, supports and enforce all Company policies and procedures
Review and research payer specific requirement to determine required documentation and accurate billing
Skills:medical collections, communication and analytical skills, customer service skills, medical record, medical terminology, customer service, call center, health care, medical billing, benefit verification, prior authorization, claims processing, insurance, medical claim, accounting, medical claims processing, insurance verification, collection, accounts receivable, data entry, medicare, medical, accounts payable, reconciliation, collections customer service, medicaid, health insurance, collections accounts receivableTop Skills Details:medical collections,communication and analytical skills,customer service skills,medical record,medical terminology,customer service,call center,health care,medical billing,benefit verification,prior authorization,claims processing,insurance,medical claimAdditional Skills & Qualifications:Basic Qualifications: High School Diploma Ability to maintain confidentiality and discretion in business relationships and exercise sound business judgment. Prioritize and execute based on customer and/or business urgency Verify third party payer to obtain authorization and benefits and eligibility (online or telephonically) Conforms to, supports and enforce all Company policies and procedures Review and research payer specific requirement to determine required documentation and accurate billing One year experience to initiate and follow up on insurance authorizations with Managed Care Plans One year experience to verify and understanding benefits and eligibility for different plan types One year experience to review and understand different types of medical criteria to include review of various clinical documentation One year experience with ICD 10 diagnosis codes One year of experience in Microsoft Office programs like Excel, Microsoft teams, and Outlook One year experience in online insurance company portal site to initiate and check status of auth One year experience in virtual communication experience Demonstrates knowledge of basic accounting skills. Excellent telephone communication skills and customer service skills. Demonstrates excellent problem-solving skills and negotiating skills Soft Skills: ability to prioritize a worklist and work in production environment, excellent written and verbal skills Ability to work effectively and exercise sound business judgment in a team environment, as well as independently.Additional Qualifications: Ability to prioritize a worklist and work in production environment Excellent written and verbal skills One year experience initiating authorization to insurance company for durable medical equipmentExperience Level:Intermediate LevelAbout TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.