What are the responsibilities and job description for the Out of Network Services Representative position at First Managed Care Option, Inc.?
First Managed Care Option, Inc. is currently looking to hire a representative in the Out of Network Provider Services Department to support our Workers’ Compensation Medical Bill Review Unit in the repricing of non-participating provider charges in accordance with Medicare and state regulations as well as department objectives.
As an Out of Network Provider Services representative, you will work as part of a team to establish and maintain relationships with representatives from provider’s offices, billing companies and First MCO clients.
Additionally, you’ll:
- Review, evaluate, and process workers’ compensation bills.
- Follow established state and federal medical bill review rules and regulations.
- Communicate with medical providers regarding payment.
- Research and interpret state fee schedules.
- Research and interpret Medicare rules and regulations.
- Perform provider payment negotiations in accordance with First MCO policies, Medicare fee schedule, Usual & Customary fee schedules and state regulations.
- Collaborate with other departments for possible recruitment into the First MCO network.
Must:
- Have the ability to work within deadlines.
- Maintain confidentiality in accordance with HIPAA guidelines.
- Be detail oriented with a high level of accuracy.
- Have a high level of experience with Microsoft Word and Excel.
- Have a high level of verbal and written communication.
- Customer service and telephone skills required.
First Managed Care Option, Inc., is an Equal Opportunity Employer and takes pride in maintaining a diverse environment. We do not discriminate in recruitment, hiring, training, promotion or any other employment practices for reasons of race, color, religion, gender, national origin, age, sexual orientation, marital or veteran status, disability, or any other legally protected status.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- Monday to Friday
Education:
- High school or equivalent (Preferred)
Work Location: Hybrid remote in Morris Plains, NJ 07950
