Managed Care Coordinator

Managed Care Coordinator

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Job Title: Managed Care Coordinator Duration: 5+ Months Location: Newark NJ Additional Skills: Strong knowledge of claims processing required. Job Summary: 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. - Performs a thorough analysis of claims to determine the correct course of action and takes the necessary steps to resolve - Handles 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 review or claims adjustments. - 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. Job Description: *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: - Prefers 2-3 years claims processing/investigations experience. Specialized knowledge/skills: Requires knowledge of medical terminology Requires knowledge of a claims processing platform with health insurance carrier (i.e., FACETS, QBLUE, etc.) Requires Good Oral and Written Communication skills Requires ability to make sound decisions under the direction of Supervisor Prefer knowledge of benefit contracts, enrollment, billing & claims coding/processing Prefer knowledge Managed Care principles and/or Medicaid 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