Title: Managed Care Coordinator
Location: Newark, NJ, United States
Duration: 6 Months
Job Description:
**Strong customer service and claims processing background preferred.
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, - Handles requests from physicians/members via incoming calls or correspondence based on scripts and workflows.
- 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 or outcome of claims inquiry review.
- 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.
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: - 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
All your information will be kept confidential according to EEO guidelines.
