Managed Care Provider Relations Manager jobs in Connecticut

Apple Rehab is a family owned and operated company that treats residents and staff like family too. Our expert team of senior management is located at our home office, right in Avon, CT, ensuring superior care from a local company. Our leadership is not across the country, but rather in your backyard.

Job Description 

$85,000-$95,000/ per year 

The Corporate Medicare/Managed Care Manager is responsible for ensuring the maximization of cash flow and reduced bad debt by managing resolution of problem accounts referred by the facility AR staff, Administrator and Regional A/R Managers. Also responsible for maintaining Medicare and Managed Care Program/Contracting requirements including revalidations, re-credentialing and User Access.

Qualifications

• · 3-5 years of billing and collections in a long-term healthcare environment.
• · Experience in development and delivery of training programs.
• · Must have thorough knowledge of Medicare and Managed Care billing and reimbursement regulations for skilled nursing and long term care.
• · The ability to handle multiple priorities and work independently is essential.
• · Strong communication skills and ability to work well in a high-pressure environment.
• · Must have strong working knowledge of Excel, Word, Outlook, and Billing Software programs; Point Click Care experience required.
• · Must have expert knowledge of Electronic Commerce requirements and FISS environment.

Administrative Functions:

• Manage problem accounts referred through various means:
• Direct referral from facility A/R Staff or Administrator (all claims not scheduled to pay within 15 days for Medicare and 30 days for Managed Care)
• Direct referral from Regional A/R Manager, Corp. Director of Accounts Receivable
• Review of Aging and A/R Review reports.
• Continue follow through of account to resolution, obtaining updates from all parties involved up to and including facility staff, Regional MDS and Rehab Departments, Managed Care plans, MACs, and CMS representatives. 
• Report performance deficiencies identified within facility that limit ability to maintain 100% collection of prior month claims. (ie careless errors on claims by biller, not responding to training provided, etc). Reporting should be directed to Administrator, Regional A/R Manager, and Corp. Director of Accounts receivable.
• Maintain log of activity and report at least monthly and as needed to facility A/R staff and Administrator.
• Attend monthly A/R Reviews as needed and directed by the Corp. A/R Director.
• Develop process and policy improvements as areas of concern are identified.
• Provide training to the field as needed (No Pay/Benefits Exhaust, Medicare as Secondary Payer, billing software/clearinghouse training, etc).
• Monitor Authorizations and report deficiencies weekly to Sr Management.
• Provide logon and passwords for access to Medicare CWF systems and clearinghouse for all staff (Business Office, Admissions).
• Special reports and projects as directed by VP of A/R and Revenue Management