Admin/Clerical - Managed Care Coordinator

Position: Managed Care Coordinator
Location: Hopewell, NJ
Duration: 3+ Months

Job Summary: This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.

Responsibilities:

• Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.

• Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.

• Prepare, document and route cases in appropriate system for clinical review.

• Initiates call backs and correspondence to members and providers to coordinate and clarify benefits.

• Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion.

• Reviewing professional medical/claim policy related issues or claims in pending status.

• Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening.

• *Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information.

• Perform other relevant tasks as assigned by Management.

Core Individual Contributor Competencies:

Personal and professional attributes that are critical to successful performance for Individual Contributors:

Customer Focus
Accountable
Learn
Communicate

Qualifications:

Education:

• High School Diploma required. Some College preferred.

Work experience:

• Prefer 1-2 years customer service or medical support related position.

Specialized knowledge/skills:

• Requires knowledge of medical terminology

• Requires Good Oral and Written Communication skills

• Requires ability to make sound decisions under the direction of Supervisor

• Prefer knowledge of contracts, enrollment, billing & claims coding/processing

• Prefer knowledge Managed Care principles

• Prefer the ability to analyze and resolve problems with minimal supervision

• Prefer the ability to use a personal computer and applicable software and systems

• Team Player, Strong Analytical, Interpersonal Skills
  
  Benefits:
  We offer a competitive compensation package that includes:
  · [Pay Rate]: $20 per hour W2
  o Note: Pay rate will be commensurate with experience.
  · Medical for full time employees
  · Dental, and Vision Insurance
  · Life Insurance, Short-Term Disability, Long-Term Disability, etc.