Managed Care Coordinator

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.
• 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 of 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.

Since 1995, iTech Solutions Inc., has been providing IT Consulting and Direct Hire Services to the Insurance, Financial, Communications, Manufacturing and Government sectors with local offices in Connecticut, Minnesota, Colorado, Massachusetts, Tennessee, North Carolina, and New Jersey / Pennsylvania area.

Our recruiting strategy is simple, if you want to find qualified IT professionals then use IT professionals to find them. So at iTech Solutions, our personnel are all career IT professionals with a wide range of IT experience. We can honestly say our staff understands the technologies, the complexities of finding and selecting the appropriate personnel and the pressures of running successful IT projects.

Employer will not sponsor applicants for any employment visas, at hiring or in the future, including but not limited to H-1B visas. Corp-to-Corp or subcontract personnel will not be considered for this position.

iTech Solutions, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, age, protected veterans or individuals with disabilities.