1-2 years customer service or medical support related position preferred
Knowledge of medical terminology required
Requirements:
Support Health Services and Utilization Management functions and act as a liaison between Members, Physicians, and other stakeholders
Perform review of service requests for completeness and collect non-clinical data from physicians/patients
Handle pre-certification requests from physicians/members and prepare cases for clinical review
Initiate call backs and correspondence to coordinate benefits and clarify case completion
Job description
Our client, a Health Insurance company, is looking for a Managed Care Coordinator for their Remote 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:
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.
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
