Managed Care Organization (MCO) Quality Assurance Specialist


JOB OVERVIEW

JOB TITLE:  Managed Care Organization (MCO) Quality Assurance Specialist

DEPARTMENT:  Accounting

LOCATION:  Buffalo, NY

DIRECT SUPERVISOR:  Accounts Receivable Manager


GENERAL JOB DESCRIPTION

Responsible for monitoring and corrective action for MCO insurance billings within accounts receivable ledger. Ensures that billing has been done accurately and completed timely.


SPECIFIC DUTIES & RESPONSIBILITIES

  1. Monitor MCO insurance receivables to identify errors, missed billings or other discrepancies.
     
  2. Communicate with MCO’s regarding discrepancies.
     
  3. Identify and work to resolve consumer authorization issues.
     
  4. Follow-up on all rejected billings from the MCO’s.
     
  5. Complete MCO administrative reviews when necessary to overturn rejected billings from the funding source.
     
  6. Execute MCO billing using approved software.
     
  7. Ability to work independently as well as with teams.
     
  8. Participate in maintaining a neat, clean and safe work environment.
     
  9. Perform other job-related duties as assigned by the supervisor.

EDUCATION & TRAINING

  • High school diploma or equivalency is required.
     
  • Associates Degree in business related field is preferred.

KNOWLEDGE & EXPERIENCE (if required)

  • Experience in Managed Care billing responsibilities preferred.

SKILLS & ABILITIES

  • Must have basic level of computer knowledge of computers including the use of Excel spreadsheets, databases, word processing and networks.
     
  • Perform in a professional, conscientious, and efficient manner for the purpose of ensuring a better quality of life for persons with disabilities.

WORKING CONDITIONS

WORK ENVIRONMENT:  Office

PHYSICAL DEMANDS OF THE JOB:  Sitting for extended periods of time.
Occasional lifting of not more than 15 pounds.

HOURS / SHIFTS:  37.5 – 40 hours per week. M – F 8:30 a.m. – 5:00 p.m.

CLASSIFICATION:  Full-time, salary, non-exempt, Support staff.
Range:  $34,000 - $36,000

BENEFITS:  Agency provided group health insurance.
Vision, dental, life, supplemental insurances available.
PTO and paid holiday package.
403(b) retirement with Agency match.
Employee Assistance Program

OTHER:  Western New York Independent Living, Inc. values our employee safety and follows all recommended NYS required Infectious Disease Prevention Protocols.
Western New York Independent Living, Inc. is an Equal Opportunity Employer.
Reasonable accommodations will be made for people with disabilities.
Western New York Independent Living, Inc. is a scent-free agency.


POSTING INFORMATION

Closing Date:  October 6, 2022

Cover Letter and Resume Required to:

Tina Brown, CHRCO
WNY Independent Living, Inc,
3108 Main St.
Buffalo, N.Y. 14214
Employment@wnyil.org