Care Coordinator I
- 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 precertification requests from physicians/claimants via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
- Performs three-point contact, directs care into the network, follows up on status of treatment, corresponds with providers and documents the file consistently.
- Coordinates the treatment plans proposed by providers, in accordance with established HCS protocols.
- Upon collection of clinical and non clinical information CC can authorize medical treatment and associated diagnostic testing based upon scripts or algorithms used for pre-review screening.
- Acts as liaison with client to identify issues and problems relating to care management and claim processing and forwards concerns to appropriate parties, when necessary.
- Initiates calls and correspondence to claimants, providers, and the client to coordinate courses of treatment.
- Perform other relevant tasks as assigned by management. Education/Experience:
- Minimum high school diploma or GED
- Prefers a bachelors degree.
- Requires a minimum of two years business experience, preferably in a medical support related position or health insurance environment.
- Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.
- Requires knowledge of medical terminology.
- Prefers knowledge of understanding of case management, philosophy and process. Skills and Abilities Strong typing, data entry and numeric keypad skills necessary. Must be comfortable using a calculator for simple math calculations.
- Analytical and Problem Solving Skills Customer Focus Interpersonal and Client Relationship Skills Communication (both verbal and written) and Organizational Skills Decision Making Flexibility/Adaptability.
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
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