Medical Management Coordinator

KMM Technologies, Inc.; Baltimore (MD); Hybrid; USD 42,000 - 62,000; Full time

Job summary

KMM Technologies, Inc. in Baltimore, MD is hiring a Medical Management Coordinator to support Utilization Management and clinical teams in a hybrid role.

On-site training and regular office presence are required, with at least two days per week in the office. You will review medical appeals and authorization requests, manage cases in GuidingCare, coordinate medical record retrieval, and assist with reporting and data management while delivering excellent service to providers and internal

Qualifications

• Knowledge of healthcare claims processing and medical management procedures.
• Strong communication, organizational, analytical, and customer service skills.
• Basic medical terminology and managed care concepts.

Responsibilities

• Provide administrative support to Utilization Management and clinical teams.
• Review, triage, and process medical appeals and authorization requests.
• Create and maintain cases in GuidingCare and route cases for review.
• Coordinate medical record retrieval and follow up with healthcare providers for required documentation.
• Prepare medical review packets for medical directors and independent review organizations.
• Support healthcare claims inquiries, benefit verification, authorization management, and claims adjustments.
• Review incoming requests and ensure accurate documentation and timely processing.
• Maintain records, track cases, and assist with reporting and data management.
• Communicate with providers and internal teams to resolve inquiries and obtain required information.
• Perform general administrative duties, including handling telephone calls, correspondence, and on-site mailing tasks.

Skills

Healthcare claims processing

CPT ICD-10 coding

Microsoft Office

Communication skills

Organizational skills

Time management

Education

High school diploma or equivalent

Tools

GuidingCare

Facets

SharePoint

Job description

• Job Title: Medical Management Coordinator
• Work Arrangement: Hybrid – On-site training and in-office attendance at least twice per week

Position Details

• Job Title: Medical Management Coordinator
• Location: Baltimore, MD
• Work Arrangement: Hybrid – On-site training and in-office attendance at least twice per week

Job Responsibilities

• Provide administrative support to Utilization Management and clinical teams.
• Review, triage, and process medical appeals and authorization requests.
• Create and maintain cases in GuidingCare and route cases for appropriate review and resolution.
• Coordinate medical record retrieval and follow up with healthcare providers for required documentation.
• Prepare medical review packets for medical directors and independent review organizations.
• Support healthcare claims inquiries, benefit verification, authorization management, and claims adjustments.
• Review incoming requests and ensure accurate documentation and timely processing.
• Maintain records, track cases, and assist with reporting and data management.
• Communicate with providers and internal teams to resolve inquiries and obtain required information.
• Perform general administrative duties, including handling telephone calls, correspondence, and on-site mailing tasks.

Required Qualifications

• High school diploma or equivalent.
• At least 2 years of experience in a healthcare or managed care setting.
• Knowledge of healthcare claims processing and medical management procedures.
• Working knowledge of CPT and ICD-10 coding.
• Understanding of basic medical terminology and managed care concepts.
• Strong communication, organizational, analytical, and customer service skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint.

Preferred Skills

• Hands-on experience with GuidingCare.
• Experience with Facets and SharePoint.
• Knowledge of utilization management, medical appeals, and claims adjustments.
• Experience in provider relations and medical record retrieval.
• Background in healthcare administration, managed care, or utilization management coordination.
• Familiarity with PCMR and CAU processes.

Work Arrangement

This is a hybrid position based in Baltimore, MD. Candidates must be local and available to attend on-site training and report to the office at least twice per week.

Interview Process

The selection process includes a video interview with the supervisor and an analyst.

Interested candidates