Job Details

  • Title: Managed Care Coordinator
  • Code: RCI-7961-1
  • Location: Farmingdale New Jersey (NJ) 07727
  • Posted Date: 03/31/2021
  • Duration: 6 Months

  Job Description

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 inappropriate system for clinical review.
  • Initiates callbacks 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
Qualifications:
  • High School Diploma required. Some Colleges preferred.
  • Prefer 1-2 years of customer service or medical support-related position.
  • Basic Excel skills
  • Able to handle approx. 50-60 calls a day
  • Knowledge of medical terminology be a plus
  • Requires ability to make sound decisions under the direction of Supervisor
  • Prefer knowledge of contracts, enrollment, billing & claims coding/processing
  • Knowledge Managed Care principles
  • Ability to use a personal computer and applicable software and systems