Managed Care & Authorization Coordinator

American Oncology Network; Honolulu (HI); On-site; USD 21,000 - 34,000; Full time

Job summary

Hawaii Cancer Care is seeking a Managed Care Coordinator to liaise between Financial Counseling and the Utilization Management team, coordinating benefit reviews, authorizations and referrals. You will streamline communications and perform quality control for pre-certification and prior authorizations.

You will ensure patient insurance benefits are up-to-date in EMR and billing systems while confirming services meet coverage criteria and payer guidelines.

Qualifications

• Two years of healthcare experience required in a clinical or business office setting.
• Familiarity with medical terminology and ICD9/ICD10 and CPT codes.
• Experience with medical insurance verification and pre-certification processes.
• Ability to calculate patient financial responsibility and copays/coinsurance.
• Excellent verbal and written communication skills.
• Proficiency with EMR and billing software systems.

Responsibilities

• Coordinate pre-certification and prior authorization with insurance companies.
• Review treatment plans to evaluate coverage criteria per payer guidelines.
• Verify active insurance coverage and communicate unplanned exceptions to the care team.
• Communicate with Financial Counselor, Intake, UM teams and colleagues as needed.
• Collaborate with outside entities to complete forms in a timely manner.
• Ensure compliance with federal and state laws regarding patient care, billing and collections.
• Maintain accurate EMR and billing records; adapt to overtime as required.

Skills

Healthcare experience

Medical terminology

Insurance verification

Pre-certification/pre-authorization

Communication skills

Education

High school Diploma or GED

Tools

MS Office Suite

Job description

Hawaii Cancer Care is seeking a Managed Care Coordinator to liaise between Financial Counseling and the Utilization Management team, coordinating benefit reviews, authorizations and referrals. You will streamline communications and perform quality control for pre-certification and prior authorizations.

You will ensure patient insurance benefits are up-to-date in EMR and billing systems while confirming services meet coverage criteria and payer guidelines.