JOB TITLE: Managed Care Clerk 

EFFECTIVE DATE: 2024

PROGRAM: Registration 

REPORTS TO: Registration Manager

FACILITY: CSU 

CITY: Bartow/Lakeland

JOB STATUS: Full-time

FLSA: Non Exempt

Job Summary: 

The Managed Care Clerk will interview patients at the BCSU and LCSU workstations to obtain all necessary billable account information. The Managed Care Clerk will verify insurance, obtain demographic data, and assist with the Managed Care Department. The Managed Care Clerk must have reliable transportation to travel daily to the Bartow and Lakeland CSU locations. As a Managed Care Clerk, you must be professional, cordial, friendly, and calm in stressful situations. Peace River Center is looking for a focused and detail-oriented person. Full-Time Monday- Friday 8am-4:30pm.

General Expectations:

In the performance of their respective task and duties, all employees are expected to conform to the following:

1. Fully understand and consistently exhibit all of Peace River Center's Core Values while fostering the same with all PRC staff.
2. Professional computer literacy levels.
3. Experience in administrative work would be advantageous.
4. Perform quality work within deadlines with or without direct supervision.
5. Work effectively as a team contributor on all assignments.
6. Work independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
7. An employee in this position must be able to react to change productively.
8. Gather demographic and insurance information for verification and data entry in order to complete the admission process for the patients to the CSU. Accurate data entry is required.
9. Assist with attending daily CSU staff meetings for updates/status of all client admissions/discharges.
10. Assisted with utilization and discharge reviews and scheduled peer reviews according to payor requirements.
11. Assist with submitting clinical records for appeals following no authorization obtained and denial of authorization.
12. Assist with updating the CSU payor log and distribute as required.
13. Ability to adhere to company and program dress code standards.
14. Interact professionally with other employees, customers, and vendors.
15. Maintain a friendly disposition.
16. Ability to report to work with good personal hygiene.

Essential Duties/Requirements/Activities:

• Ability to abide by principles of EEO compliance and a workplace of dignity and respect.
• Ability to work cooperatively in a group and team setting.
• Ability to take guidance and direction from supervisors.
• Ability to arrive to work and be ready to work on time.
• Ability to professionally communicate with other employees and outside vendors, as required.
• Ability to show respect to all others.
• Ability to travel to both CSU locations, assist with Managed Care shortages, assist with utilization and discharge reviews, and schedule peer reviews according to payor requirements. Accurate data entry is required.
• Ability to deal with stressful situations or irate recipients.
• Ability to sit for long periods.
• Able to learn quickly, prioritize, and handle multiple tasks and heavy telephone traffic.
• Ability to work independently.
• Answer phone calls and redirect calls to the appropriate individual.
• Greet patients.
• Validate medical insurance coverage.
• Ability to listen to and understand information and ideas presented verbally and in writing.
• Complete financials with patients, including verifying and obtaining authorizations for insurance, financials, and data entry.
• Ability to review, record, and report information relevant to authorizations.

Qualifications:

Education:

High School Diploma/GED, some college preferred

Experience:

2 Years of registration experience, preferably in a Medical Facility

Certifications:

None

Training:

None

Knowledge and Skills:

Written and verbal communication skills

Organizational Skills

Highly motivated

Presentation Skills

Typing Minimum 45-50 wpm

Safety Equipment

Universal Precautions

Comply with Occupational Safety and Health Administration (OSHA) rules and regulations.

Life Safety Equipment (fire extinguisher)

Transportation:

Must have reliable transportation-the ability to travel to both Bartow and Lakeland locations daily.

Machines, Tools, and Equipment Used:

Computer, telephone, fax, copier, calculator

Supervisory Relationship(s)

None

Work Environment:

The work environment is fast-paced and consists of exposure to physical conditions typical of a normal office environment. The populations cared for will include patients who are confused, delusional, irrational, agitated, or uncooperative. Most of the job is performed while sitting, although the work may require occasional standing or walking and/or the lifting and carrying of small objects. A small amount of travel may be required for meetings etc. to another PRC location.

EEO Statement

One of the greatest assets of the PRC is the ethnic, cultural, and social diversity of its employees. PRC takes great pride in the diversity and values and respect of all its employees, regardless of race, color, sex, marital status religion, national origin, ancestry, genetic information, age, disability, gender identification, or sexual orientation.