Managed Care Supervisor jobs in Massachusetts
Managed Care Supervisor supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Being a Managed Care Supervisor experienced in utilization review techniques and protocols. Requires a bachelor's degree. Additionally, Managed Care Supervisor typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. The Managed Care Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. To be a Managed Care Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. (Copyright 2024 Salary.com)
Recently Added Managed Care Supervisor jobs
- Mass General Brigham
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Somerville, MA
FULL_TIME
-
Description
About Us
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.
Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
General Summary
Under general direction of the Supervisor the incumbent (MCSR) is primarily responsible for working collaboratively with primary care Practices, specialty care Practices, primary care physicians, referring physicians, and patients to ensure that required referrals are obtained and appropriately recorded in the relevant practice management systems prior to scheduled patient visits. The MCSR will communicate with patients, physicians and payor representatives as necessary in order to accomplish this, utilizing available management reports to follow-up on unresolved issues and denied claims. The MCSR is responsible for performing various administrative and clerical duties required to support these functions and, on an as-needed basis, may be required to perform other tasks.Principal Duties and Responsibilities- Primarily responsible for working collaboratively with BWH practices to obtain missing referrals for specialty services prior to scheduled visits. Duties include running Ontrac worklist and checking information in the legacy systems to determine if a valid referral for the visit exists. If a valid referral is in the legacy systems incumbent will be responsible for linking to the referral number to the appropriate visit(s). For visits without a valid referral number in the legacy systems, incumbent will use the various payer technologies to obtain referral and authorization numbers for BWH primary care practices. For specialty visits, contacting external PCPs to obtain referral numbers, coding the work in Ontrac and entering the information in the legacy systems.
- Responsible for documenting and tracking the number of referrals that are generated and obtained. Also responsible for following-up with practices who do not immediately issue a referral, noting the reason for the delay. For referrals that are denied, documenting this information. Interfacing with practices and patients to report referral information. Complying with Patient Service Center productivity and customer service standards.
- Responsible for verifying and updating patient registration information, including insurance, demographic and patient data in order to perform referral management function. Work collaboratively with the Registration Department to resolve registration issues. Responds to questions regarding open accounts or managed care/insurance issues.
- Interfacing with patients will be necessary when information required to obtain an insurance referral is not complete. This includes, calling patient to obtain current PCP, insurance, visit information. Also responsible for communicating patient responsibility to contact payer via the Member Services Department or web-sites to update inaccurate information to maximize payment for visits. In addition, incumbent will be responsible for communicating benefit plan information to patients when necessary. Responsible for follow-up with patients to ensure that information has been updated with payers.
- Works with all Brigham Support Staff and leadership to prioritize and facilitate referral processes to maintain integrity of service standards.
- Develop a clear understanding of the various payor referral and authorization process and requirements for departmental policies and procedures.
- Receives inquiries from customers, investigates and disseminates information to requestor and wider audiences as appropriate.
- Works with Ontrac tool & reporting to review billing rejections to resolve insurance issues to maximize reimbursement. This includes, but is not limited to, obtaining retroactive referral numbers for bills that were denied for no referral.
- Identify need for escalation of issues or problems to appropriate supervisor or manager.
- Performs other duties as assigned.
QualificationsQualifications- 1-3 years Healthcare experience
- Bachelors degree or equivalent experience
- Proficient in Office Software
- Call Center environment experience
Skills/Abilities* The ability to set prioritize and follow through with responsibilities
* Ability to exercise appropriate judgment with sensitive and confidential material
* The ability to successfully resolve conflict
Ability to communicate and interact effectively with all levels of hospital personnel
* Ability to maintain confidentiality with regard to all phases of the work
* Ability to withstand the pressure of continual deadlines and receipt of work with variable requirements
* Ability to concentrate and maintain accuracy in spite of frequent interruptions
* Ability to be courteous, tactful, and cooperative throughout the working day
* Ability to use judgment in carrying out all phases of the work
* Ability to use standard office equipment including computers, photocopy and facsimile machines, and readers/printers
* Excellent Customer Service Skills, demonstrated ability to use appropriate judgment, independent thinking and creativity when resolving customer issues.
* Computer Literate; knowledge of BICS, IDX, Percipio
EEO StatementMass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.
Primary Location: MA-Somerville-MGB Assembly RowWork Locations:MGB Assembly Row399 Revolution DriveSomerville 02145Job: Finance/AccountingOrganization: Mass General BrighamSchedule: Full-timeStandard Hours: 40Shift: Day JobEmployee Status: RegularRecruiting Department: MGB Patient Service Center (PSC)Job Posting: May 24, 2024
Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged. - 5 Days Ago
- Beth Israel Lahey Health Performance Network
-
Wakefield, MA
FULL_TIME
- Job Type: Regular Time Type: Full time Work Shift: Day (United States of America) FLSA Status: Non-Exempt When you join the growing BILH team, you're not just taking a job, you’re making a difference ...
- Just Posted
- Beth Israel Deaconess Medical Center
-
Boston, MA
FULL_TIME
- When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Type: Regular Scheduled Hours: 40 Work Shift: Day (United States of America) Job Su...
- 9 Days Ago
- Brigham and Women's Hospital
-
Boston, MA
FULL_TIME
- Description GENERAL SUMMARY/ OVERVIEW STATEMENT: Working under the general direction of the Senior Billing Manager, the Managed Care Coordinator will help ensure that all professional radiation oncolo...
- 30 Days Ago
- Aperion Care
-
Wellesley, MA
FULL_TIME
- Come join the talented staff at AdviniaCare! We’re seeking compassionate and skilled Full-time weekday and Part-time weekend Nurse Supervisors. Great work life balance, comprehensive benefits and comp...
- 23 Days Ago
- Aperion Care
-
Salem, MA
FULL_TIME
- Come join the talented staff at AdviniaCare! We’re seeking a compassionate and skilled Nurse Supervisor for 3p - 11p shift. Great work life balance, comprehensive benefits and competitive salary offer...
- 13 Days Ago
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