Managed Care Coordinator

Managed Care CoordinatorTitle: Managed Care CoordinatorLocation: Newark, NJ, United StatesDuration: 6 MonthsStrong customer service and claims processing background preferred. 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 informationHandles requests from physicians/members via incoming calls or correspondence based on scripts and workflowsPrepare, document and route cases in appropriate system for clinical reviewInitiates call backs and correspondence to members and providers to coordinate and clarify benefits or outcome of claims inquiry reviewUpon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completionReviewing professional medical/claim policy related issues or claims in pending statusUpon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screeningNon Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical informationPerform other relevant tasks as assigned by ManagementCore Individual Contributor Competencies: Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus Accountable Learn CommunicateQualifications: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 SupervisorPrefer knowledge of contracts, enrollment, billing & claims coding/processingPrefer knowledge Managed Care principlesPrefer the ability to analyze and resolve problems with minimal supervisionPrefer the ability to use a personal computer and applicable software and systemsTeam Player, Strong Analytical, Interpersonal SkillsAll your information will be kept confidential according to EEO guidelines.