Medical Care Coordination Specialist (Case & Claims)

Brighton Health Plan Solutions, LLC; Chapel Hill (NC); Vor Ort; USD 42.000 - 66.000; Vollzeit

Zusammenfassung

Brighton Health Plan Solutions, LLC seeks a Care Coordinator to support MagnaCare's utilization review and workers’ compensation case management. You will collect data, enter demographics, and coordinate with nurses, employers and claimants to keep claims accurate.

Responsibilities include scheduling, data tracking, QA adherence, and handling inquiries with professionalism. Strong communication and Excel skills, plus the ability to work independently and in a team, are essential.

Qualifikationen

• Superior oral and written communication skills.
• Strong PC skills (Excel is a must).
• Excellent organizational skills.
• Ability to maintain professional demeanor under pressure.
• Ability to work independently and as a team player.
• Minimum of one year’s experience in the medical field.
• Bachelor's degree or equivalent experience.

Aufgaben

• Collect data from claimant representative, physician, or hospital; verify claimant case status and provider network status.
• Set up cases in system in accordance with workflows, policies and procedures.
• Assist Nurse Case Reviewers with non-clinical tasks and information requests.
• Enter required case demographics and transcribe clinical information.
• Handle incoming calls and coordinate with employers, employees, physicians and adjusters to gather medical status.
• Schedule medical appointments for members with in-network facilities and verify attendance.

Kenntnisse

Oral communication

Written communication

Excel

Organizational skills

Independent work

Team player

Ausbildung

Bachelor's degree or equivalent

Tools

Excel

Jobbeschreibung

Brighton Health Plan Solutions, LLC seeks a Care Coordinator to support MagnaCare's utilization review and workers’ compensation case management. You will collect data, enter demographics, and coordinate with nurses, employers and claimants to keep claims accurate.

Responsibilities include scheduling, data tracking, QA adherence, and handling inquiries with professionalism. Strong communication and Excel skills, plus the ability to work independently and in a team, are essential.