Medical Management Coordinator

Record retrieval: Issue and track both requests on a fixed cadence, call provider offices on day 3, and index documents in GuidingCare/SharePoint; only non-responsive providers escalate. Intake and case build; screen all channels daily, return misroutes, confirm member/claim data, and queue clean cases oldest-first.

Our client, a Health Insurance company, is looking for a Medical Management Coordinator for their Baltimore, MD location.
 
Responsibilities:

• Assist analyst with triaging and entering appeals; this includes printing and assisting with medical records request and create overturn notices.
• Assist with creating shell cases in GuidingCare and create appeal letters.
• Intake and case build; screen all channels daily, return misroutes, confirm member/claim data, and queue clean cases oldest-first.
• Record retrieval: Issue and track both requests on a fixed cadence, call provider offices on day 3, and index documents in GuidingCare/SharePoint; only non-responsive providers escalate.
• Prepare MD and IRO packets and track vendor due dates.
• Closure and notification: Route decisions, generate and mail letters and FFRNs, monitor the adjustment queue, and notify providers the day the decision is made.

 
Requirements:

• Knowledge of CPT and ICD-10 coding, Claims, GuidingCare, Facets Legacy and G6.
• Minimum 2 years’ experience in health care/managed care setting 
• Previous appeals, ability to review letter of appeal, identify claims.
• Nasco experience is a plus.

 
Why Should You Apply?

• Health Benefits
• Referral Program

#alljobs
#mcbWhy Should You Apply?

• Health Benefits
• Referral Program