Our client, a Health Insurance company, is looking for a Medical Management Coordinator for their Baltimore, MD location.
Responsibilities:
Assist analyst with triaging and entering appeals; this includes printing and assisting with medical records request and create overturn notices.
Assist with creating shell cases in GuidingCare and create appeal letters.
Intake and case build; screen all channels daily, return misroutes, confirm member/claim data, and queue clean cases oldest-first.
Record retrieval: Issue and track both requests on a fixed cadence, call provider offices on day 3, and index documents in GuidingCare/SharePoint; only non-responsive providers escalate.
Prepare MD and IRO packets and track vendor due dates.
Closure and notification: Route decisions, generate and mail letters and FFRNs, monitor the adjustment queue, and notify providers the day the decision is made.
Requirements:
Knowledge of CPT and ICD-10 coding, Claims, GuidingCare, Facets Legacy and G6.
Minimum 2 years’ experience in health care/managed care setting
Previous appeals, ability to review letter of appeal, identify claims.