Managed Care Specialist

Job Summary

A company is looking for a Managed Care Specialist to review physician claims and ensure accurate payments based on contractual terms.

Key Responsibilities

• Review and analyze physician claims for payment discrepancies and investigate underpaid claims
• Engage with insurance carriers to correct underpayments and request claim adjustments
• Collaborate with team members and assist in auditing complex claims while maintaining organized documentation

Required Qualifications, Training, and Education

• Bachelor's degree in a relevant field
• No licensure or certification required
• No additional experience required for candidates with a Bachelor's degree
• Four (4) years of experience required with an Associate's degree
• Eight (8) years of experience required with a High School diploma or GED