Managed Care Coordinator

Managed Care Coordinator

Title: Managed Care Coordinator

Location: Newark, NJ, United States

Duration: 6 Months

Job Description

Strong customer service and claims processing background preferred. 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
• Handles requests from physicians/members via incoming calls or correspondence based on scripts and workflows
• 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 or outcome of claims inquiry review
• 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

All your information will be kept confidential according to EEO guidelines.