M Care Work Values

Daily Duties at M Care:

Claims Investigator, Business Analyst Liaison between MCare and affiliated network providers for contract issues. • Investigated provider claims payment for indication that reimbursement rate was not accurate to submit for systems configuration processes. • Follow up with providers through meetings for educational purposes and contractual issues. • Identified claims payment errors for systems implementation. Worked with claims payment area, configuration, provider network, support services and financial departments to guarantee reimbursement rates pay correctly according to contracted rates with customer. • Direct work with UB-92, HCFA, DRG problem solving and all other pertinent facets of claims processing. Strong customer satisfaction background gained from providers, hospitals, facilities and doctors offices while educating and resolving payment issues and contract disputes with affiliates that participate within the MCare health insurance network. • Processed medical claims for insured members of the MCare network at an accuracy level of 99% based on financial accuracy and clerical levels. Plans included HMO, PPO, POS, Medicaid, Medicare and self funded groups. • Provider networking done through face to face visits with new providers to ensure educational needs as well as problem resolution. • Worked with providers to make sure credentialing standards were met and standards were consistent with contractual obligations. • Contracted position through Blue Cross Blue Shield for 1.5 years due to buyout of MCare. • Proficient with Microsoft Office programs and Amisys and Maccess Claims processing programs.

What they like about M Care:

The social vibrance of a hiring firm is very important to you. Your ability to make and maintain friendships there is a critical part of your decision. You would likely be dissatisfied with a workplace that is quiet, cold, or otherwise not particularly social. When you investigate a new hiring company, ask recruiters, managers, and potential co-workers about the social life and opportunities there. This is especially important when you are relocating; moving dramatically alters your social sphere both inside and outside the workplace.

Tags

Healthcare, Manager, Claims, Insurance, call center

Skills

Presentation, Ecommerce Strategy and digital marketing channels optimization - SEO, SEM, email, affiliates - for high-profile accounts., Sales Support, Software Implementation, Leadership

These are some of the questions we asked our climbers about their experiences with M Care: