Managed Care Coordinator

Integrated Resources Inc.; Newark (NJ); On-site; USD 40,000 - 55,000; Full time

Job summary

A leading company is seeking a Managed Care Coordinator in Newark, NJ, to support Health Services and Utilization Management. This role involves liaising with members and providers, ensuring service request reviews, and handling claims inquiries. Ideal candidates will have customer service experience and familiarity with medical terminology.

Qualifications

• 1-2 years customer service or medical support experience preferred.
• Knowledge of medical terminology required.
• Ability to make sound decisions under supervision.

Responsibilities

• Review service requests for completeness and handle inquiries from members and physicians.
• Coordinate and clarify benefits or outcomes of claims inquiries.
• Prepare and document cases for clinical review.

Skills

Customer Service

Communication

Analytical Skills

Education

High School Diploma

Some College

Job description

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

Job Description

Title: Managed Care Coordinator

Location: Newark, NJ, United States

Duration: 6 Months

Job Description:

**Strong customer service and claims processing background preferred.

Job Summary:

This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.

Responsibilities: -

• Performs review of service requests for completeness of information, - Handles requests from physicians/members via incoming calls or correspondence based on scripts and workflows.
• 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 or outcome of claims inquiry review.
• 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.
  Core Individual Contributor Competencies: Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus Accountable Learn Communicate

Qualifications:

• Education: - High School Diploma required. Some College preferred.
  Work experience: - Prefer 1-2 years customer service or medical support related position.
  Specialized knowledge/skills: - Requires knowledge of medical terminology - Requires Good Oral and Written Communication skills - Requires ability to make sound decisions under the direction of Supervisor
• Prefer knowledge of contracts, enrollment, billing & claims coding/processing
• Prefer knowledge Managed Care principles
• Prefer the ability to analyze and resolve problems with minimal supervision
• Prefer the ability to use a personal computer and applicable software and systems
• Team Player, Strong Analytical, Interpersonal Skills

Additional Information

All your information will be kept confidential according to EEO guidelines.