Managed Care Coordinator jobs in Silver Spring, MD

• Obtaining referrals and pre-authorizations as required for procedures.
• Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
• Reviewing patient bills for accuracy and completeness and obtaining any missing information.
• Continual follow-up on outstanding accounts through contracts/inquiries to third-party and governmental payers to facilitate prompt resolution or payment based on the Follow-Up department guidelines.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Calling insurance companies regarding any discrepancy in payments if necessary. Request refunds or retractions as appropriate.
• Identifying and billing secondary or tertiary insurances.
• Analyze and calculate the payment and contractual amounts on remittances received from payers. Includes denied claims to ensure that patients are billed appropriately.
• Reviewing accounts for insurance of patient follow-up.
• Researching and appealing denied claims.
• Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
• Setting up patient payment plans and work collection accounts.
• Updating billing software with rate changes.
• Updating cash spreadsheets and running collection reports.

In addition to these general duties, an individual employer may request that you perform other duties that fit with your training and background experience or provide further training for new duties.