Top Managed Care Executive jobs in New York

SUMMARY:

The Referral and Managed Care Specialist will be responsible for (1) coordinating patient referrals (2) providing support to patients and staff regarding the managed care referral process.

This employee will work as part of the PCMH team with the following essential duties and responsibilities:

• Direct referrals to specialists and track referral status
• Prioritizes referrals by their urgency and addresses them in a timely manner.
• Ensures complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred specialists.
• Verify insurance information for patients, including contacting insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
• Obtain authorization from managed care organizations (MCOs) procedure and specialty referrals.
• Report outstanding referrals to providers in a timely manner.
• Reschedule referrals as necessary and requested by the Medical Provider.
• Utilize eClinicalWorks (eCW) and EpicCareLink to manage referral process.
• Work with HHC Advantage and other referral resources to electronically submit referral requests and obtain patient results.
• Serve as liaison between CFH and MCOs and collaborate with the Billing Department to obtain preauthorization.
• Verify assignment of a CFH Primary Care Provider (PCP) and inform staff when a PCP change is needed.
• Provide support to medical biller in the claim generation process.
• Provide assistance to patients and staff regarding the managed care referral process. Referrals specialist serves as a point of contact for patients and specialists for any questions or rising concerns. Assist in problem solving potential issues related to their referral due to language or social barriers.
• Performs additional duties, as needed.

JOB QUALIFICATIONS:

• Education: Bachelor's Degree preferred
• Experience:
  • 1-2 years of administrative or clinical experience in a medical setting preferred.
  • Familiarity with ICD Codes, and MCOs.
• Skill Sets:
  • Excellent organizational and communication skills required.
  • Attention to detail.
  • Ability to multi-task and meet assigned deadlines from a variety of management staff.
  • Ability to work in a fast-paced and ever changing environment.
  • Leadership and/or facilitation experience with a group or team.
  • Public presentation and speaking skills.
  • Extremely proficient in Microsoft Office Suite; employee is willing and able to:
    • Create, edit, and interpret charts, tables and spreadsheets (via Microsoft Excel).
    • Effectively manage, filter and sort data (via Microsoft Excel).
    • Create well-organized documents and outlines (via Microsoft Word).
    • Manage mailbox and calendar (via Microsoft Outlook).