Medical Management Coordinator

Position Details:

• Job Title: Medical Management Coordinator
• Location: Baltimore, MD
• Work Arrangement: Hybrid – On-site training and in-office attendance at least twice per week

Job Responsibilities:

• Provide administrative support to Utilization Management and clinical teams.
• Review, triage, and process medical appeals and authorization requests.
• Create and maintain cases in GuidingCare and route cases for appropriate review and resolution.
• Coordinate medical record retrieval and follow up with healthcare providers for required documentation.
• Prepare medical review packets for medical directors and independent review organizations.
• Support healthcare claims inquiries, benefit verification, authorization management, and claims adjustments.
• Review incoming requests and ensure accurate documentation and timely processing.
• Maintain records, track cases, and assist with reporting and data management.
• Communicate with providers and internal teams to resolve inquiries and obtain required information.
• Perform general administrative duties, including handling telephone calls, correspondence, and on-site mailing tasks.

Required Qualifications:

• High school diploma or equivalent.
• At least 2 years of experience in a healthcare or managed care setting.
• Knowledge of healthcare claims processing and medical management procedures.
• Working knowledge of CPT and ICD-10 coding.
• Understanding of basic medical terminology and managed care concepts.
• Strong communication, organizational, analytical, and customer service skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint.

Preferred Skills:

• Hands-on experience with GuidingCare.
• Experience with Facets and SharePoint.
• Knowledge of utilization management, medical appeals, and claims adjustments.
• Experience in provider relations and medical record retrieval.
• Background in healthcare administration, managed care, or utilization management coordination.
• Familiarity with PCMR and CAU processes.

Work Arrangement:

This is a hybrid position based in Baltimore, MD. Candidates must be local and available to attend on-site training and report to the office at least twice per week.

Interview Process:

The selection process includes a video interview with the supervisor and an analyst.

Interested candidates: Please share your updated resume along with your current location, relevant healthcare experience, and availability for an interview.