Overview
Managed Care Specialist Jobs in Altoona, PA at University of Pittsburgh Medical Center (UPMC)
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.
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
UPMC is an Equal Opportunity Employer/Disability/Veteran
Title: Managed Care Specialist
Company: University of Pittsburgh Medical Center (UPMC)
Location: Altoona, PA
Category:
