Medical Management Coordinator

Iconma,-Llc.; Baltimore (MD); On-site; USD 45,000 - 65,000; Full time

Job summary

Health Insurance Company in Baltimore, MD seeks a Medical Management Coordinator to support appeals processing and case management in a fast-paced environment.

The role covers intake, record retrieval, and packet preparation for MD/IRO reviews, with emphasis on accurate data handling and timely communication with providers.

Qualifications

• Knowledge of CPT and ICD-10 coding and healthcare claims processing.
• Minimum 2 years’ experience in health care/managed care setting.
• Experience with appeals, reviewing letters of appeal, and identifying claims.
• NASCO experience is a plus.

Responsibilities

• Triage and enter appeals; print and assist with medical records requests.
• Create shell cases in GuidingCare and draft/letters of appeal.
• Intake and case build; screen channels daily and queue clean cases oldest-first.
• Record retrieval; index documents in GuidingCare/SharePoint; escalate non-responsive providers.
• Prepare MD and IRO packets and track vendor due dates.
• Closure and notification: route decisions, mail letters and FFRNs, notify providers when decision is made.

Skills

CPT coding

ICD-10 coding

Claims knowledge

GuidingCare

G6

Tools

GuidingCare

Facets Legacy

G6

Job description

Our client, a Health Insurance company, is looking for a Medical Management Coordinator for their Baltimore, MD location.

Responsibilities:

• Assist analyst with triaging and entering appeals; this includesprinting and assisting with medical records request and create overturn notices.
• Assist with creating shell cases in GuidingCare and create appeal letters.
• Intake and case build; screen all channels daily, return misroutes, confirm member/claim data, and queue clean cases oldest-first.
• Record retrieval: Issue and track both requests on a fixed cadence, call provider offices on day 3, and index documents in GuidingCare/SharePoint; only non-responsive providers escalates.
• Prepare MD and IRO packets and track vendor due dates.
• Closure and notification: Route decisions, generate and mail letters and FFRNs, monitor the adjustment queue, and notify providers the day the decision is made.

Requirements:

• Knowledge of CPT and ICD-10 coding, Claims, GuidingCare,Facets Legacy and G6.
• Minimum 2 years’ experience in health care/managed care setting
• Previous appeals, ability to review letter of appeal, identify claims.
• Nasco experience is a plus.