Insurance & Precertification Care Coordinator

American Oncology Management Company

Honolulu (HI)

On-site

USD 25,000 - 35,000

Full time

5 days ago

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Job summary

Hawaii Cancer Care is seeking a Managed Care Coordinator to act as the liaison between the Financial Counselor and the Utilization Management and Intake teams. You will coordinate managed care reviews of benefits, authorizations, referrals and communicate managed care components for patient services.

Ensure patient insurance data in EMR and billing software is up to date while verifying coverage appropriateness.

Qualifications

High school diploma or GED required; higher education is a plus.
Minimum two years in healthcare field, preferably clinical or business office.
Experience with medical terminology.
Experience verifying pre-certification and prior authorization.
Excellent verbal and written communication skills.
Knowledge of ICD-9, ICD-10 and CPT codes.
Ability to calculate patient responsibility and collect co-pays/coinsurance.

Responsibilities

Coordinate pre-certification and prior authorization with insurance companies and internal teams.
Review patient schedules and treatment plans to evaluate coverage criteria per payor guidelines.
Identify active insurance coverage for treatments and communicate exceptions to the clinic.
Review new treatment orders and ensure required forms are completed by outside entities.
Maintain open communication with Financial Counselor, Intake, UM, and other teams as needed.
Adhere to federal and state laws related to patient care, billing, and collections.
Work overtime when required with advance notice.
Keep records organized and ensure equipment is maintained.