Admin/Clerical - Managed Care Coordinator
Alpha Business Solutions
Job Description
Job Description
Position: Managed Care Coordinator
Location: Newark, NJ (Hybrid)
Duration: 5+ Months
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.
Core Individual Contributor Competencies: Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus Accountable Learn Communicate
Qualifications: Education: - High School Diploma required. Some College preferred.Work experience: - 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, enrolment, 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
Benefits:We offer a competitive compensation package that includes:
· [Pay Rate]: $19 per hour W2
o Note: Pay rate will be commensurate with experience.
· Medical for full time employees
· Dental, and Vision Insurance
· Life Insurance, Short-Term Disability, Long-Term Disability, etc.
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