Senior Managed Care Specialist

Centerstone is among the nation’s leading nonprofit behavioral health systems with thousands of employees dedicated to delivering care that changes people’s lives. A dynamic, well-established organization, we offer rewarding opportunities to serve all ages in a variety of settings. Come talk to us about joining the Centerstone team!

JOB DESCRIPTION:

SUMMARY OF POSITION

In addition to working as a Managed Care Specialist, the Senior Specialist has the responsibility of coordinating the daily task within the Managed Care team assigned to lead. The Senior MCS provides weekly status update reports to the team and leadership.
Also, this role will review accounts to resolve concerns with payer information that is not correctly entered.  Assists with obtaining benefit information and sets up coverage information to ensure proper billing. Responsible for processing of denials due to no authorizations received and works to resolve.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Timely and accurate data entry.
• Maintain a collaborative relationship with Support Services team members and clinical staff.
• Timely and accurate completion of authorization, referrals or payer information for set up the financial chart.
• Compliance with annual completion of Relias training as required.
• Coordinating the daily task within the Managed Care team assigned to lead.
• The Senior MCS will also facilitate a daily team meeting to check in with the team members to review task assignment obtain project status updates as well as answer questions, concerns or view workflow processes.
• Creates and reports weekly status updates to the progress of the team work load and assignments. 
• The Managed Care Specialist is responsible for reviewing the daily reports which pertain to the Managed Care team assigned.  
• These reports include authorizations, service package assignments, referral information or updating payer information.
• The MCS works to set up the financial chart and reviews payer information in order to bill for services.  
• The MCS will review accounts to resolve concerns with payer information that is not correctly entered.  
• This can include review of future scheduled appointments with lapsing authorizations. Must maintain a working knowledge of payer requirements for proper scheduling and authorizations.  
• The MCS is Responsible for reviewing daily service activity failures with regard to authorizations. Also includes billing failures for coverage issues.
• Assists with obtaining benefit information and sets up coverage information to ensure proper billing. Responsible for processing of denials due to no authorizations received and works to resolve.

KNOWLEDGE, SKILLS & ABILITIES

QUALIFICATIONS

         

Education Level              

High School Diploma or GED required. 

Years of Experience       

Three to five years administrative experience preferred.

Certification/Licensure 

N/A

PHYSICAL REQUIREMENTS

Standing – 10%

Sitting – 90%

Squatting – Occasional

Kneeling – Occasional

Bending – Occasional

Driving – Occasional

Lifting – Occasional

Time Type:

Full time

Pay Range:

$15.75--$22.00

Delivering care that changes people's lives starts with our employees. Below are just some of the great benefits Centerstone employees enjoy:

• Medical, dental, and vision health coverage

• Flexible Spending and Health Savings Accounts

• 403b retirement plan with company match

• Paid time off and ten paid holidays

• AD&D Insurance, Life Insurance, and Long Term Disability (company paid)

• Employee Resource Groups

• Continuing education opportunities

• Employee Assistance Program

Centerstone is an equal opportunity employer. Employment at Centerstone is based solely on a person's merit and qualifications directly related to professional competence. We treat all clients and colleagues with dignity and respect.

At Centerstone, we use our values as a guide for what we do. Respect, Expertise, Integrity and Empowerment are at the heart of every interaction at Centerstone, and particularly rooted in our Culture.

Our approach to culture is to create an environment that encourages, supports and celebrates the voices and experiences of our employees. We are committed to a culture of empowerment, respect, integrity and expertise that powers our innovation and connects us to each other, our clients and the communities we serve.

Centerstone is also committed to a strong culture of quality and safety, celebrating role-models who champion best practices for quality, clinical risk, and patient safety.