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Job Requirements

EDUCATION AND TRAINING:

•  Must have High School diploma or GED 

•  Must have one of the following:

o  1 Year related experience

o  Certificate in related field plus 6 months work experience

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Managed Care Associate (MCA)

Texas MedClinic San Antonio Full-Time
$11.00 - $13.64 / hour
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GENERAL JOB SUMMARY:  The role of the Managed Care Associate (MCA)  includes, but is not limited, to the following  responsibilities:   to  provide  clerical  and  administrative  support  primarily  to  the  Managed  Care  Account Representative  (MCAR)  position;  to  focus  on  Managed  Care  Organization  Collections;  to  perform  routine  billing functions;  to handle  Managed Care external and internal calls; and to occasionally perform other duties within the billing office based on business requirements as assigned by the Private Billing Section Supervisor (PBSS).


WORK  HOURS:  The  normal  work-week  is  35-40  hours/week  full-time,  Monday  through  Friday  as  scheduled. 

Occasional overtime or variations may be required or authorized.




ESSENTIAL KNOWLEDGE, SKILLS, AND ABILITIES:

•  Must possess good customer service skills

•  Must be organized, detail-oriented and able to adapt quickly to stressful work environment

•  Must have effective reasoning and deductive ability 

•  Must be able to work in team environment, as well as independently

•  Must be able to read, correctly interpret and follow written guidelines/protocols

•  Must be able to learn and apply new skills 

•  Must be able to communicate effectively in English (grammar, spelling, writing, and verbal skills)

•  Must maintain confidentiality when dealing with medical information

•  Must have basic computer and keyboarding skills: Microsoft Word required; Excel and Outlook preferred

•  Experience using a 10-key adding machine preferred

•  Medical software experience preferred

•  Basic knowledge of private and/or managed care insurance preferred

•  Basic knowledge of CPT and ICD codes preferred

•  Knowledge of medical terminology, its spelling and abbreviations preferred

•  Ability to communicate in Spanish helpful


ESSENTIAL JOB FUNCTIONS AND DUTIES: 

CLERICAL

1.  Alphabetizes and files correspondence received

2.  Prepares letters and bills (copying, stapling and stuffing)

3.  Pulls, photocopies and organizes records or faxes (charts, Explanation of Benefits (EOBs) and receivables, etc.) as requested

4.  Processes phone credit card payments

5.  Generates insurance claims or patient statements as needed


BILLING/COLLECTION DUTIES AND REPORTS

1.  Processes HMO-PPO Final Demand Tasks

a.  Reviews report of balances that qualify for Final Demand Letter to be sent to patient

b.  Makes necessary corrections on those that do not qualify for Final Demand Letter

c.  Reviews  for  corresponding  credit  balances  in  NextGen  or  Centricity  and  sends  to  Managed  Care  Account Representative (MCAR) as needed

d.  Documents action taken; updates task status and task log accordingly

e.  Prints, folds and stuffs Final Demand Letters going out each day 

f.  Works  the  encounters  with  bad  addresses;  researches  in  Patient  Information  Worksheet  (PIW);  corrects  and 

updates

g.  Reviews PIW for data entry errors; corrects errors and updates as needed

h.  Sets follow up date appropriately  according to action taken 

i.  Makes sure that follow up dates do not exceed 10 days from due date

j.  Must work Final Demand tasks on a daily basis and does not to exceed 3 days from create date

2.  Works the HMO-PPO Ins Bal Task In Progress status 

a.  Follows up on “In Progress” and takes necessary action needed for payment on claim

b.  Re-files corrected claim and/or adjusts as noted by MCAR

c.  Documents action taken; updates task status to “In Progress”

d.  Sets follow up date according to schedule provided

e.  Makes sure follow up dates do not exceed 10 days from due date

f.  Completes within 30 days from create date or sooner

3.  Works the Prelist tasks

a.  Reviews for corresponding credit balances in NextGen or Centricity  and sends to MCAR as needed

b.  Processes all balances from $3.01 to $15.00 to Internal Collections

c.  Documents action taken 

d.  Updates status

e.  Must work on Prelist tasks on a daily basis and must not to exceed 3 days from create date

4.  Processes daily Non-Payment EOB’s as assigned 

a.  Posts non-revenue actions to patient accounts (i.e., applied to deductible, need more information from Patient)

b.  Posts routine insurance disallowances to patient accounts according to contractually allowed amounts

c.  Identifies insurance determinations that need to be appealed and forwards EOB to appropriate MCAR 

d.  Documents actions taken

e.  Works daily to be completed by no more than 3 days from receipt date

5.  Verifies benefits and eligibility by either via phone call and website and/or RealMed

a.  Ensures that eligibility has been checked prior to balance billing the patient as needed

b.  Ensures that billing address is according to the plan benefits verified

6.  Reassigns Worklog tasks as needed when not properly assigned


OTHER

1.  Interacts with staff members professionally

2.  Follows company policies and procedures (time and attendance, dress code, etc)

3.  Promotes teamwork and facilitates company goals

4.  Answers incoming calls prior to 5 rings

5.  Returns customer messages within 2 working days

6.  No more than 3 agency cancels in a three month period (errors in sending to collections)

7.  No excessive past filing deadlines or past appeals deadlines written off in a given month

8.  Makes sure all actions taken on an account are documented

9.  Daily correspondence (Non-Payment EOBs) should be completed by no more than 3 days from receipt date

10. Consistently provides PBSS with feedback on their AR and how to improve efforts

11. Works a minimum of 300 accounts/encounters per week

12. Correctly uses office equipment 

13. Works safely

14. Other duties as assigned

15. Must be punctual and reliable in attendance


CUSTOMER SERVICE SKILLS:

1.  Answers department phones

2.  Meets the service expectations of patients

3.  Answers questions from internal and external customers in a timely and professional manner

4.  Responds to request from internal and external customers in a timely and professional manner

5.  Resolves problems identified by patients and other external customers


6.  Resolves problems identified by internal customers 

7.  Meets the service expectations of internal customers

8.  Meets the service expectations of external customers

9.  Follows through on commitments

10.  Interacts with co-workers in other departments in manner that promotes teamwork and facilitates company goals


11. Logs in to phone queue daily 

EDUCATION AND TRAINING:

•  Must have High School diploma or GED 

•  Must have one of the following:

o  1 Year related experience

o  Certificate in related field plus 6 months work experience

Recommended skills

Implantable Cardioverter Defibrillator
Explanation Of Benefits (Eob)
Cpt Coding
Claims
Managed Care
Medical Software
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