Medical Management Coordinator

Pay Range: $22.27hr - $27.27hr Job Overview: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care. Essential Functions: Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation. Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems. Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Level: High School Diploma. Experience: 3 years experience in health care claims/service areas or office support. Preferred Qualifications: Two years' experience in health care/managed care setting or previous work experience within division. Knowledge of CPT and ICD-10 coding. Knowledge, Skills and Abilities (KSAs): Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient. Excellent communication, organizational and customer service skills., Proficient. Knowledge of basic medical terminology and concepts used in managed care., Proficient. Knowledge of standardized processes and procedures for evaluating medical support operations business practices., Proficient. Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy., Proficient. Ability to pay attention to the minute details of a project or task, Proficient. Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point, Proficient. Benefits: Our Benefits Include: Medical, Dental, and Vision Insurance 401(k) Retirement Plan Health Savings Account (HSA) Disability Insurance (Short-Term and Long-Term) Life and AD&D Insurance Paid Sick Leave (where required by applicable state or local law) Supplemental Insurance Plans Identity Theft Protection Pet Insurance Employee Wellness Programs Employee Assistance Program (EAP) Career Growth and Professional Development Opportunities Disclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Systems Inc. reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws. About Cynet Systems Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading technology staffing and workforce solutions company serving Fortune 500 companies, government agencies, and enterprise organizations across the United States and Canada. We deliver agile, scalable talent solutions across IT, engineering, life sciences, clinical, and professional staffing, powered by a high-performing recruitment engine operating across North America and Asia. As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers. Our organization is certified to ISO 9001, ISO 14001, ISO 27001, and SOC 2 Type II standards, reflecting our commitment to quality, security, operational excellence, and customer success.