Managed Care Account Representative

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The Managed Care Account Representative (MCAR) will be responsible for timely collection of account balances from managed care insurance carriers and patients with the assistance of the Managed Care Associate (MCA).  The MCAR also provides clerical and administrative support relating to managed care issues to insurance carriers, patients, clinics and administrative personnel.  Based on business requirements, the MCAR will be expected to occasionally perform other duties within the billing office 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 (including evenings and Saturdays) may be required or authorized.

Education & Training:

  • Must have High School diploma or GED
  • Must have one of the following:
    • 2 years of related experience
    • Certificate in related field plus 1 year related work experience

Position Advancement:

The MCAR has the opportunity for advancement to the Managed Care Collector (MCC) position after meeting the following requirements:

  1. After being in the MCAR position for 2 years:
  • Must score at least 3.40 on annual date-in-position evaluation for last 2 years
  • Must not have a Performance Improvement Plan (PIP) in last 12 months
  • Must have a good time and attendance record with no suspensions in last 12 months
  • Must not have written disciplinary action in personnel file in last 12 months
  • Must have Department Manager or PBSS recommendation for promotion

OR

  1. Must have a minimum of 4 years applicable medical billing and/or collections and 6 months in the MCAR position:
  • Must score at least 3.40 on all TMC evaluations since beginning of employment
  • Must not have received any time and attendance memos in the last 6 months
  • Must not have any written disciplinary action in personnel file
  • Must not have a performance improvement plan since beginning of employment
  • Must have Department Manager or PBSS recommendation for promotion

Essential Knowledge, Skills & Abilities:

  • Must possess good customer service skills
  • Basic knowledge of private and/or managed care insurance required
  • Basic knowledge of CPT and ICD codes and modifiers required
  • Basic knowledge of medical terminology, its spelling and abbreviations required
  • Good computer and keyboarding skills: Microsoft Word required; Excel and Outlook preferred
  • Must have a working knowledge of Accounts Receivable (AR)
  • Medical software experience required, current TMC medical software experience preferred
  • Must have a working knowledge of EDI processing and medical applications systems skills
  • Must be organized, detail oriented and able to adapt quickly to stressful work environment
  • Must be able to work in team environment, as well as independently
  • Must be able to communicate effectively in English (grammar, spelling, writing, and verbal skills)
  • Must possess effective reasoning and deductive ability
  • 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 manage time to ensure completion of tasks, while paying attention to detail
  • Must be able to prioritize duties to understand what duties take priority and when issues need escalation
  • Must maintain confidentiality when dealing with medical information
  • Medical transcription experience helpful
  • Experience using a 10-key adding machine preferred
  • Ability to communicate in Spanish helpful

Essential Job Functions & Duties:

CLERICAL
  1. Routinely alphabetizes and files correspondence received as needed
  2. Prepares letters and bills (copying, stapling and stuffing)
  3. Creates and maintains files for appeals and correspondence
  4. Pulls, photocopies, and organizes records or faxes (charts, Explanation of Benefits (EOBs) and receivables, etc.) as requested
  5. Handles patient payments (credit card, check and cash) by phone or walk-in
  6. Generates insurance claims or patient statements as needed
BILLING/COLLECTION DUTIES AND REPORTS
  1. Works the HMO-PPO Ins Bal Task
    1. Follows up and takes necessary action needed for payment on claim
    2. Re-files corrected claim and/or adjusts as needed
    3. Identifies insurance determinations that need to be appealed and submits with appropriate documentation
    4. Documents action taken; updates task to appropriate status
    5. Sets follow up date according to schedule provided
    6. Makes sure that follow up dates do not exceed 10 days from due date
    7. Completes within 30 days from create date or sooner
  2. Works RealMed Edit/Erred claims to ensure timely submission of claims
    1. Updates RealMed Erred claims with the necessary information to reduce processing time
    2. Ensures all eligibility is verified and claims addresses are set to process in the most efficient way (electronic whenever possible)
    3. Appropriately uses “delete” claims from RealMed; understands that may result in additional time delays and only deletes as indicated by edit issue
    4. Updates any corrections in RealMed in NextGen
    5. Works RealMed Edit/Erred Claims within 3 days of submit date
  3. Works Final Demand Tasks as needed not to exceed 14 days from task create date
    1. Transfers corresponding credits to balances as needed
    2. Makes sure that follow up dates do not exceed 10 days from due date
    3. Assists MCA as needed with task not to exceed 14 days from create date
  4. Works the Prelist tasks daily to Collections all balances greater than $15.00; Internal Collections when needed ($3.01-$15.00)
    1. Confirms guarantor name/minors issues
    2. Checks mailing address
    3. Transfers appropriate credit balances from NextGen and/or Centricity as appropriate prior to transfer to collections
    4. Adds the required transactions and fees prior to sending to external vendor
    5. Documents action taken
    6. Updates status and follow up dates as needed
    7. Makes sure that follow up dates do not exceed 10 days from due date
    8. Prelists not to exceed 14 days from task create date
  5. Understands system tasks and dates to ensure timely follow up
    1. Updates all actions taken with clear and concise notes
    2. Updates the worklog status and follow up date (NextGen)
    3. Uses subject line as directed to allow organization of workflow
    4. Reassigns WorkLog Tasks from HMO-PPO ADMIN as needed or any tasks not properly assigned
    5. Documents all actions taken on all accounts
  6. Process daily Non-Payment EOB’s as assigned
    1. Posts non-revenue actions to patient accounts (i.e., applied to deductible, need more information from patient)
    2. Posts routine insurance disallowances to patient accounts according to contractually allowed amounts
    3. Keeps PBSS informed of any payers that are consistently not paying according to contract
    4. Works daily to be completed by no more than 3 days from receipt date
  7. Identifies and resolves problems
    1. Identifies recurring processing errors and work with the corresponding teams (internal or external) for resolution
    2. Documents issues in patient accounts and maintains record of problems and status of resolution
    3. Discusses recurring problems with PBSS to ensure appropriate corrective action is taken
    4. Understands the need for escalation in order to reduce claim payment and/or delays
  8. Work Coordination
    1. Communicates with supervisor, other MCARs and MCAs on a regular basis
    2. Assigns tasks to MCA via work log status
    3. Monitors completion of tasks assigned to MCA via worklog status
    4. Assists in training MCA to perform assigned tasks
    5. Organizes workload to ensure backlog is within minimum standard
OTHER
  1. Interacts with staff members professionally
  2. Follows company policies and procedures (time and attendance, dress code, etc)
  3. Promotes teamwork and facilitate 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 the receipt date
  10. Works a minimum of 210 accounts/encounters per week
  11. Consistently provides PBSS with feedback on their AR and how to improve efforts
  12. Correctly uses office equipment work safely
  13. Other duties as assigned
  14. Must be punctual and reliable in attendance

Customer Service Skills:

  1. Answer questions from internal and external customers in a professional manner
  2. Respond to request from internal and external customers in a professional and timely manner
  3. Resolve problems identified by patients
  4. Resolve problems identified by internal customers
  5. Meet the service expectations of patients
  6. Meet the service expectations of internal customers
  7. Meet the service expectations by external customers
  8. Resolve problems identified by external customers
  9. Follow through on commitments
  10. Interact with co-workers in other departments in a manner that promotes teamwork and facilitates company goals
  11. Log in to phone queue daily

Working Conditions & Risks:

Work is indoors in a well lighted, and seasonally heated and cooled business office. Job hazards are estimated to be minimal (low risk). Potential risk exists from accidents while using routine office equipment.

Physical Requirements:

Position requires occasional need to lift heavy (30-50lbs) boxes from chest height to floor to chest height.  Prolonged sitting, sorting, moving about, and intermittent typing approximately 4-6 hours per day routinely. Good vision, good hearing, and clear speech required (correctable). Repetitive motions consist of extended periods of upper body and upper limb movements (arms, hands, and wrists) prolonged use of phone and computer.

Before applying for this position you need to submit your online resume. Click the button below to continue.


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