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Company Contact Info
- Trenton, NJ
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Managed Care Coordinator
Integrated Resources, Inc • Trenton, NJ
Posted 2 months ago
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.
- 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