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Careers Integrated Resources Inc
Managed Care CoordinatorCareers Integrated Resources Inc • Newark, NJ, United States
Managed Care Coordinator

Managed Care Coordinator

Careers Integrated Resources Inc • Newark, NJ, United States
2 days ago
Job type
  • Full-time
Job description

Managed Care Coordinator

Title: Managed Care Coordinator

Location: Newark, NJ, United States

Duration: 6 Months

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.

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Managed Care Coordinator • Newark, NJ, United States

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