Managed Care Coordinator

American Oncology Management Company; Honolulu (HI); On-site; USD 25,000 - 35,000; Full time

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.

Skills

Verbal communication

Written communication

Insurance knowledge

Medical terminology

ICD/CPT codes

Education

High school Diploma or GED

Tools

MS Office

Excel

PowerPoint

Outlook

Job description

Location:

Hawaii Cancer Care

Hiring Range:

$18.22 - $25.18

Job Description Summary:

A Managed Care Coordinator serves as the liaison between the Financial Counselor and the Utilization Management and Intake team by coordinating managed care review of benefits, authorizations, referrals and streamlining communication of the managed care components for patient services. Performs the quality control function for pre-certification and prior authorization. The Managed Care Coordinator ensures the patients' insurance benefits are kept up to date in the electronic medical records (EMR) and billing software while also verifying the patient's services meet coverage appropriateness.

Primary Job Duties & Responsibilities:

• Monitors and coordinates internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals, seeking support from provider or pharmacy team when applicable.

• Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to evaluate coverage criteria with payor guidelines and preferred treatment.

• Review patients' treatment plan(s) and identify if insurance benefit coverage is active, all unplanned exceptions are to be communicated to provider/clinic team immediately.

• Review and identify new treatment orders.

• Communicate openly and routinely throughout the course of the workday with various teams such as the Financial Counselor Team, Intake Team, UM team and coworkers through Teams, phone calls, emails and in person to discuss items as needed to complete managed cares.

• Work closely with outside entities to ensure full collaboration and completion of forms and items needed in a timely and sometimes urgent manner.

• Understand and comply with all Federal and State laws and regulations pertaining to patient care, rights, safety, billing, and collections.

• Will be expected to work overtime when given sufficient notice of required overtime.

• Keep work area and records in a neat and orderly manner.

• Maintain all company equipment in a safe and working order.

• Adhere to all AON and departmental policies and procedures, including Revenue cycle policies and procedures.

• Performs other duties and projects as assigned.

Job Qualifications and Requirements:

Education: High school Diploma or GED required. Further education or degree a plus Certifications/Licenses: Previous Experience (including minimum years of experience):

• A minimum of two-years prior experience in the healthcare field, preferably in a clinical or business office setting required.

• Prior Medical terminology.

• Prior Medical insurance verification.

• Prior Verifying pre-certification and/or prior authorization with medical insurance.

• Excellent proven verbal and communication skills needed.

• Proven Insurance knowledge requirements including an understanding of medical terminology, ICD9, ICD10 and CPT codes.

• Ability to calculate and collect patients' responsibility and insurance co-pay/coinsurance.

Core Capabilities:

• Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.

• Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.

• Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.

• Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations.

• Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.

• Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.

• Computer Skills:

  Proficiency in MS Office Word, Excel, Power Point, and Outlook required.

  Ability to use multiple screens to perform required job functions.

  Ability to navigate multiple applications and tab in and out of workflow to complete tasks.

Travel : 0%

Standard Core Workdays/Hours: Monday to Friday 8:00 AM - 5:00 PM.

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