Managed Care Coordinator

Job Title: Managed Care Coordinator

Duration: 5+ Months

Location: Newark NJ


Additional Skills: -
Strong
knowledge of claims processing required.

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, collection and transfer of
non-clinical data, and acquisition of structured clinical data from
physicians/patients.- Performs a thorough analysis of claims to determine the
correct course of action and takes the necessary steps to resolve - Handles
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 review or claims
adjustments. - 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.


Job Description:


*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: -

Prefers
2-3 years claims processing/investigations experience.

Specialized knowledge/skills: - 
 

• Requires knowledge of medical terminology


• Requires knowledge of a claims processing platform with
  health insurance carrier (i.e., FACETS, QBLUE, etc.)


• Requires Good Oral and Written Communication skills


• Requires ability to make sound decisions under the direction
  of Supervisor


• Prefer knowledge of benefit contracts, enrollment, billing
  & claims coding/processing


• Prefer knowledge Managed Care principles and/or Medicaid


• 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

If you are not interested in looking at
new opportunities at this time I fully understand. I would in that case be
appreciative of any referrals you could provide from your network of friends
and colleagues in the industry. We do offer a referral bonus that I’d be happy
to extend to you if they turn out to be a great fit for my client.