Managed Care Representative

Job Summary

A company is looking for a Managed Care Services Rep.

Key Responsibilities

• Verify insurance coverage and eligibility for patients prior to medical procedures or hospital admissions
• Obtain pre-authorization from insurance companies for medical procedures, surgeries, and diagnostic tests
• Educate patients about their insurance benefits and assist in resolving insurance-related issues

Required Qualifications

• High School Diploma or Equivalent required; Associate's Degree in a related field preferred
• 2-3 years of experience in healthcare administration, insurance authorization/verification, scheduling, or medical billing
• In-depth knowledge of health insurance plans, including managed care, PPOs, HMOs, and Medicare/Medicaid
• Familiarity with medical terminology, coding systems (ICD-10 and CPT), and healthcare billing processes
• Proficient in using computer systems and software applications related to insurance verification and claims processing