Key Facts

Remote From:

Full time

Expert & Leadership (>10 years)

English

Hard Skills

Care Coordination Utilization Management Medical Abbreviations Case Management Systems Health Policies Insurance Reviews Provider Model Phone Screening Clinical Data Analysis Benefits Realization Management Case Report Forms Medical Office Procedures Enrollment Management Billing Contract Management Managed Care Claims And Litigation Management Customer Centricity Continuous Training

Other Skills

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Computer Literacy
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Customer Service
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Decision Making
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Accountability
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Analytical Skills
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Teamwork
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Verbal Communication Skills
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Social Skills

ICONMA

Human Resources, Staffing & Recruiting

About ICONMA

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company type: Large

Industry: Human Resources, Staffing & Recruiting

Founded: 2018

Company size: 1001 - 5000

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Job description

Our Client, a Health Insurance company, is looking for a Managed Care Coordinator for their Hopewell, NJ location.

Responsibilities:

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.
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.

Requirements:

Core Individual Contributor Competencies: Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus Accountable Learn Communicate
High School Diploma required. Some College preferred.
Prefer 1-2 years customer service or medical support related position.
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

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities

ICONMA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to any status protected by applicable law.

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