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Managed Care Assistant I

2 months ago

Rocklin, United States Intercare Holdings Insurance Services, Inc. Full time

Job Type

Full-time

Description

Summary:

The Managed Care Assistant I is a non-supervisory position that coordinates all managed care/medical bill review/MPN/reporting and other support related activities across the InterMed organization. This non-clinical position to assist and support the Bill Review and Managed Care staff by performing general and administrative tasks.

Essential Duties and Responsibilities:

  • Screen referrals received from claims examiner for attached medical report prior to assignment to a Utilization Review Nurse (clinical), under direction of supervisor.
  • Contact doctor offices & other health care disciplines involved in the care of injured workers to obtain current medical reports, orders & work status; adhering to call script.
  • Responsible for maintaining a daily diary.
  • Data entry in electronic claim file, sharefile, and Managed Care system.
  • Format and document letters or correspondence according to documentation process standards as directed.
  • Generate and format letters from the electronic claim file as directed.
  • Create and submit referrals to vendor partners or client vendors when necessary.
  • Participate in ongoing training/professional development.
  • Answer phone calls related to utilization review, nurse case management, bill review, and medical provider networks.
  • Refer all clinical related questions or issues to licensed staff, analysts, or Supervisor/Managers.
  • Data entry for indexing which requires identifying claim numbers, payees, ICD codes and dates of service.
  • Assist in researching claim numbers and locating bills in the system.
  • Print and mail Zero EORs
  • Be aware of potential compromise in a patient's safety. Refer to proper authority.
  • Uses plain language to communicate (written and verbal) with injured workers, claims examiners, and clients.
  • All other non-clinical related tasks as assigned by clinical staff and leadership staff
Requirements

Competency:

To perform the job successfully, an individual must demonstrate the following competencies:
  • Computer Skills - must be proficient in word, excel, ten key, e-fax machine, fax machine, phone systems, and navigation of internet such including ability to surf the web on search engines.
  • Design - Demonstrates attention to detail and ability to multi-task with ability to work under pressure.
  • Knowledge - experience and knowledge with Medical billing forms (HCFA-1500 and UB facility forms)
  • Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; responds well to questions. Strong and positive customer service skills.
  • Team Work - Supports everyone's efforts to succeed. The ability to work well with others and be an essential team player.
  • Quality - Demonstrates accuracy, timeliness and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Must be able to identify issues and report them to management.
  • Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quic

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

High school diploma or general education degree (GED); some knowledge of California Worker's Compensation and medical terminology preferred. One to three months related experience and/or training; or equivalent combination of education and experience preferred.