Managed Care Coordinator

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