Medical Management Care Coordinator (Wednesday - Sunday shift)

VNS Health; New York (NY); On-site; USD 32,000 - 40,000; Full time

Benefits offered by this job

Referral bonuses

Generous PTO

Health insurance

Employer-matched retirement savings

Tuition reimbursement

FSAs for healthcare and dependent care

Career advancement opportunities

Internal mobility

Job summary

VNS Health in New York City is seeking a customer service professional to support clinical staff by entering data into the medical management information system, creating case files for services requiring authorization, and ensuring accurate claims adjudication. The role emphasizes strong problem-solving, timely data entry, confidentiality, and collaboration across teams.

Candidates should have a high school diploma, at least two years in customer service, excellent communication, and

Qualifications

• Minimum of two years of customer service experience.
• Excellent oral and written communication skills.
• Advanced PC skills, including Word, Excel or Access.
• Utilization Management experience preferred.

Responsibilities

• Obtains information from doctors/providers and enters data into the MMIS for clinical staff.
• Creates case files for services requiring authorization and maintains accurate data for prompt decisions/claims.
• Delivers strong customer service and triage with accurate data collection and target performance.
• Tracks and reports on customer complaints; identifies trends and suggests corrective actions.
• Provides feedback to leadership regarding training needs.
• Collaborates with management to improve delivery, billing and payment of services.

Skills

Customer service experience

Excellent oral and written comms

Education

High School Diploma or equivalent

Tools

Word

Excel

Access

Job description

Overview

Collects specific data in the medical management information system for the clinical staff. Resolves authorization issues as well as troubleshoots, researches and resolves related issues in a timely and efficient manner. Works under general supervision.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at20daysof paid time offand 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life andDisability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
• Interdisciplinary network of colleagues through the VNS Health Social Services Community ofProfessionals.

What You Will Do

• Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools.
• Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication.
• Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved.
• Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions.
• Provides triage and management of calls ensuring that established call performance targets are consistently achieved.
• Provides feedback to leadership regarding training needs
• Collaborates with management to determine the best approach to service customers, handle repeat vendor issues and other job-related matters to maximize and improve delivery, billing and payment of goods and services.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education: High School Diploma or equivalent required

Work Experience: Minimum of two years of experience in a customer service role required

Excellent oral and written communication skills required

Advanced personal computer skills, including Word, Excel or Access required

Utilization Management experience preferred

Pay Range

USD $23.17 - USD $28.96 /Hr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.