Sonic Healthcare USA, Inc
Job Functions, Duties, Responsibilities and Position Qualifications:
Quality is in our DNA, is it in yours?
Sonic Healthcare USA (SHUSA) has an exciting opening for a Sr. Managed Care Specialist in our Central office located in Austin, Texas .
.Not a remote opportunity. Must be located in Austin, Texas with the ability to work in-office three days a week.*
Reporting directly to the Corporate Vice President of Revenue Cycle, this position will have one overarching responsibility, to ensure the overall health of the Managed Care Accounts Receivables. The role will support both the Divisional Revenue Cycle leaders and the Corporate structure, with a focus on timely and accurate collection of Managed Care cash.
Duties & Responsibilities:
- Works directly with Divisional Revenue Cycle Leadership on AR & Denials related to Managed Care and Commercial payors. Some will be escalated by the divisions, others will be identified by you, and you will initiate intervention.
- Develop and implement a house-wide Managed Care AR escalation policy.
- Develop and maintain a house-wide tracking/trending tool. ROI impact will also be tracked.
- Appeal claims denials with documentation and an argument and follow up with the insurance company about reimbursement.
- Draft templates for various issues related to claims/audits (general appeals letter, COVID appeals letter, audit response, generic consent, etc.)
- Subject Matter Expert on documentation, workflow, and process for managed care & commercial payers medical and reimbursement policies.
- Experienced with third party payer policies and regulations to educate our divisions and/or clients.
Education and Experience:
- Commensurate Years Work Experience will be considered. Bachelor’s Degree preferred.
- 5-7 years of experience in one or more of the following areas: Managed Care or Health plan, Revenue Cycle, Denials/Appeals, Payer Audits, Contract Modeling or Underpayment Recover.
- Strong understanding of Managed Care: ACA, ACO, PHO, MSO (HMO, PPO and Government programs)
Knowledge, Skills, and Abilities:
- Ability to problem solve and think critically to identify trends.
- Accurately read and interpret Managed Care/Commercial payor contracts.
- Accurately read and interpret insurance explanation of benefits.
- Analysis and evaluate various sources of data to improve quality and further the goals and objectives of the organization.
- Computer proficiency with Microsoft Word, Excel, Outlook and other office software applications.
- Excellent verbal and written communication skills.
- Utilize time management skills to manage daily tasks and meet production & quality metrics.
- Work well with others and promote a team environment.
- Supervisory experience a plus
Scheduled Weekly Hours:
40
Work Shift:
Job Category:
Administration
Company:
Sonic Healthcare USA, Inc
Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
