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  • Trenton, NJ

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Managed Care Coordinator

Integrated Resources, Inc • Trenton, NJ

Posted 2 months ago

Job Snapshot

Full-Time
Travel - Negligible
Experience - 1 to 5 years
Degree - High School
Healthcare - Health Services
Admin - Clerical

Job Description

Job Description:

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. -
  • 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.
  •  

Job Requirements

Qualifications:

  • 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

 

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