Managed Care Coordinator
Job Description
Job Description
Hybrid role 2-3 days in office a week, Top NJ firm, immediate Hire!
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.
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 in appropriate system for clinical review. - Initiates call backs 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. Qualifications: Education: - High School Diploma required. Some College preferred.Work experience: - Prefer 1+ 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
Recommended Jobs
Electrical Engineer
APM Terminals About APM Terminals A.P. Moller - Maersk is an integrated container logistics company working to connect and simplify its customer's supply chains. As the global leader in shipping…
Weekend Tractor Drivers- Drop and Hook
Join our team at a NJ-based FedEx Ground Contractor as an experienced CDL A Tractor Driver. We are seeking dedicated professionals who have a clean license and can pass a background/DOT Drug Screenin…
Executive Director, Drug Safety and Pharmacovigilance
About Acadia Pharmaceuticals Acadia is advancing breakthroughs in neuroscience to elevate life. Since our founding, we have been working at the forefront of healthcare to bring vital solutions to …
COMMUNITY HEALTH ASSISTANT (PER DIEM)
About us At Cooper University Health Care,our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovati…
Behavioral Health Director (CV903-221) - Operations Division
Volunteers of America Delaware Valley is looking to hire a Behavioral Health Director to join our highly dynamic and growing team. They will report the VP of Program Operations. The Director will p…
Flow Cytometrist 1
Flow Cytometrist 1 Syneos Health® is a leading fully integrated biopharmaceutical solutions organization built to accelerate customer success. We translate unique clinical, medical affairs and comme…
Host
HOST JOB DESCRIPTION San Patricios, by The Dead Rabbit Group, is looking for hosts to join our growing team in Jersey City, New Jersey . Hosts are the first to deliver our ‘Welcome Home’ hos…
Senior Cybersecurity Analyst
When you join the Cambridge team, you are part of a skilled and talented global community that is united by a set of core values: commitment, integrity, and perseverance. Join our team and help us co…
CT Tech
Overview Join our team as an evening shift, PRN, Cat Scan-A Cat Scan Technician (CT) in Westwood, NJ. Why Join Us? Thrive in a People-First Environment and Make Healthcare Bette…
Transportation manager
Purpose of Your Job Position The primary purpose of your job position is to coordinate the Campus transportation services. To include medical and outpatient transport, family Subacute transport and …