Job Details

Managed Care Follow Up Specialist

Elevate Patient Financial Solutions has an exciting career opportunity available as a Managed Care Follow Up Specialist. This position will be remote based. The full time schedule for the position will be 8 AM-5 PM, Monday-Friday.

The Managed Care Appeals Follow Up Specialist will monitor and track the status of submitted reconsiderations, appeals, and disputes by ensuring timely follow-up and accurate resolution. The Appeals Follow Up Specialist will conduct research and coordination needed to evaluate, process, respond to, and refer or close appeals. This position will operate within healthcare, insurance, or related fields, and must understand policies, regulations, and specific circumstances surrounding each case.

Essential Duties and Responsibilities

• Review outstanding hospital reconsideration, redeterminations, and appeals for potential resolution within policy guidelines.
• Ability to maintain high-volume caseload and adhering to the timeliness standard of the Appeals while conducting the due process review. Call payors to confirm appeal status: received, not on file, upheld, or overturned. Confirm appeal addresses, fax numbers, or payor portal information and timely appeal guidelines.
• Manage applicable claims resolution workflows: 2nd level appeal, write off's due to exhausted appeal levels or untimely appeals, resubmitting appeals not received, and monitoring appeals for payment.
• Assist in the achievement of high performing and positive work environment that will promote the mission of ElevatePFS Payment Recovery Services.
• Enhance professional growth and development through bridge online learning, and weekly team meetings.
• Demonstrate attention to detail in researching appeal cases and documenting notes for proper case processing.
• Complies with client, departmental, and organizational policies and procedures as they relate to the job.
• Refers complex or sensitive issues to the attention of the supervisor to ensure corrective measures are taken in a timely fashion.
• Accepts and learns new tasks as required and demonstrates a willingness to work where business needs are largest.
• Demonstrate knowledge of HIPAA privacy standards and ensure compliance with system PHI privacy practices.
• Be cross trained in multiple clients and hospital system platforms.
• Communicate in a professional with fellow coworkers, clinical staff, coders, supervisors, and representatives from payor organizations
• Follow departmental guidelines for lunch, breaks, requesting time off, and shift assignments.
• Regular and timely attendance.
• Perform other duties as assigned.

Qualifications and Requirements

• Graduation from an accredited college or university with an Associate degree in Business Administration, Healthcare Administration, or closely related field and 2 years of relevant work experience.
• Minimum of two (2) years in medical collections.
• A basic understanding of the Revenue Cycle Process.
• Experience with payor online portals.
• Organized and detail oriented.
• Basic Microsoft Applications knowledge: Outlook, Excel, Word.

Benefits

• Medical, Dental & Vision Insurance
• 401K (100% match for the first 3% & 50% match for the next 2%)
• 15 days of PTO
• 7 paid Holidays
• 2 Floating holidays
• 1 Elevate Day (floating holiday)
• Pet Insurance
• Employee referral bonus program
• Teamwork: We believe in teamwork and having fun together
• Career Growth: Gain great experience to promote to higher roles