Managed Care Specialist

at  UPMC

Job ID: 5989702228
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Altoona Reg Health Srvcs
Department: BMA Test Scheduling
Location: 1414 9th Avenue, Altoona, PA
Union Position: No
Salary Range: $ 16.84-25.72 USD

QUALIFICATIONS:

• Graduate of an accredited Medical Secretarial school, accredited Medical Administrative assistant program, accredited Medical Assistant program, or LPN program (valid state license) or one-year vocational-technical school; minimum six months related experience and/or training; or equivalent combination of education and experience.
• Medical terminology required.LICENSURE, CERTIFICATIONS, AND CLEARANCES:
• Act 34

PURPOSE:

Answers all incoming phone calls in the test scheduling area and schedules all testing requested by physicians within the group practice for test orders. Coordinates patient care by required pre-certification

RESPONSIBILITIES:

• Fax requests and letters to provider or facility performing test/procedure.
• Understands roster management and can assist with it as assigned
• Takes incoming calls and relays messages appropriately.
• Ensure timely flow of information regarding managed care contacts and/or patients to specialists, primary care physicians, staff, and patients.
• Gives patients complete information regarding any test or procedures being performed, including any preparation requirements.
• Schedules diagnostic testing or procedures outside of for patients.
• Pre-certifies patient services and obtains necessary approval of specialties, hospital admissions, emergency treatment, out-of-office testing, rehabilitation, DME, and any other necessary service.
• Applies principles of specific managed care products to each task to ensure contractual compliance.
• Updates patient chart with scheduled appointment date and time, prep, prints instructions if any.
• Inform HIS Department if any information needs to be sent to the consulting physician’s office.
• Works with manager to maintain files, and coordinates patient care as it relates to quality assurance and utilization review.
• Responds to documents and orders from physicians regarding the ordering of tests, procedures, and appointments with specialists per physician orders.
• Keeps current with managed care products and how changes may affect them.