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.

We do have referral bonus of $500 per candidate, if you refer any of your friends or colleague who are looking out for the same job.

thanks

Deepak

732-844-8717