Care Authorization & Benefits Coordinator

Hawaii Cancer Care; Honolulu (HI); Hybride; USD 25 000 - 34 000; Plein temps

Résumé du poste

Hawaii Cancer Care seeks a Managed Care Coordinator to act as the liaison between the Financial Counselor and Utilization Management, coordinating managed care reviews for benefits, authorizations, and referrals.

You will perform quality control for pre-certification and prior authorization, ensuring patient insurance benefits are up to date in EMR and billing software while verifying services meet coverage requirements.

Qualifications

• Two years of healthcare experience required.
• Experience with medical terminology (ICD-9/10, CPT) preferred.
• Ability to verify pre-certification and prior authorization with insurers.
• Strong verbal and written communication and attention to detail.

Responsabilités

• Coordinate pre-certification and prior authorization with insurers, including peer-to-peer and appeals.
• Review patient schedules and treatment plans to assess coverage against payer guidelines.
• Ensure insurance benefits are active in EMR and billing systems; communicate coverage issues promptly.
• Collaborate with Financial Counselor, Intake, UM, and clinic teams via Teams, calls, and emails.
• Work with external entities to complete forms and documents in a timely manner.
• Adhere to all laws, regulations, and Revenue Cycle policies; handle overtime as needed.

Connaissances

Medical terminology

Verbal communication

Insurance verification

Pre-certification

Prior authorization

Communication skills

Formation

High school Diploma or GED

Outils

MS Office (Word, Excel, PowerPoint, Outlook)

Description du poste

Hawaii Cancer Care seeks a Managed Care Coordinator to act as the liaison between the Financial Counselor and Utilization Management, coordinating managed care reviews for benefits, authorizations, and referrals.

You will perform quality control for pre-certification and prior authorization, ensuring patient insurance benefits are up to date in EMR and billing software while verifying services meet coverage requirements.