…appropriate community agencies and organizations, the TRICARE Lead Agent office, and the Managed Care Support Contractor. + Maintain adherence to JCAHO, URAC,

…hospital reimbursement as it relates to different payers such as Medicare, Medi-cal, Managed Care and private insurance plans. Riverside Community Hospital is a

…hospital entities, departments, marketing, finance, recruitment, operations, compliance, managed care , credentialing/enrollment, human resources, and information

…to accommodate patient and provider needs. Inputs patient insurance and managed care plans, including prior authorizations, referrals, and pre-certifications.

…pertinent to patient service and billing procedures: including basic knowledge of all managed care plans and which insurers require a copayment or referral.

…and operational initiatives including new services/programs, revenue enhancement, expense reduction, managed care utilization systems, and strategies + Supervise

…and make appropriate referrals, including referrals to the Behavioral Health Managed Care Organization (BHMCO) as needed. Contact member(s), providers

…from Primary Care Physician and/or Specialty Physician when required by payers, Managed Care , and traditional Medicaid and enters information into the health

…across the continuum of care .* Expertise in entitlement eligibility, managed care , guardianship, immigration and naturalization laws.* Ensures efficient and

…other staff, patients, and outside third parties for insurance authorizations and other managed care related issues. + Respond to patient inquiries related to