Our client, a Health Insurance company, is looking for a Medical management Coordinator for their Baltimore, MD/Hybrid location.
Responsibilities:
- The role of the MMC is to assist analyst with triaging and entering appeals. They will print and assist with medical records request and create overturn notices. They are required to assist with creating shell cases in GuidingCare and create appeal letters.
- Intake and case build MMCs screen all channels daily, return misroutes, confirm member/claim data, and queue clean cases oldest-first.
- Record retrieval MMCs issue and track both requests on a fixed cadence, call provider offices on day 3, and index documents in Guiding Care/SharePoint; only non-responsive providers escalate.
- MMCs prepare MD and IRO packets and track vendor due dates.
- Closure and notification MMCs 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, etc… GuidingCare and Facets Legacy and G6.
- Minimum 2 years' experience in health care/managed care setting or previous work experience within division
- Knowledge of CPT and ICD-10 coding, previous appeals, ability to review letter of appeal, identify claims. Nasco is a plus.
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities