Managed Care Coordinator
Posted on: May 28, 2023
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.
Prefer 1-2 years medical support related position.
Requires knowledge of medical terminology
Requires Good Oral and Written Communication skills
Requires the ability to use computers and applicable software and systems
Keywords: Collabera, Tuscaloosa , Managed Care Coordinator, Other , Pennington, Alabama
here to apply!