Managed Care Coordinator

About the role

A Managed Care Coordinator serves as the liaison between the Financial Counselor and the Utilization Management and Intake team by coordinating managed care review of benefits, authorizations, referrals and streamlining communication of the managed care components for patient services. Performs the quality control function for pre-certification and prior authorization. The Managed Care Coordinator ensures the patients’ insurance benefits are kept up to date in the electronic medical records (EMR) and billing software while also verifying the patient’s services meet coverage appropriateness.

Responsibilities

• Monitors and coordinates internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals, seeking support from provider or pharmacy team when applicable.
• Reviews assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to evaluate coverage criteria with payor guidelines and preferred treatment.
• Reviews patients’ treatment plan(s) and identifies if insurance benefit coverage is active; all unplanned exceptions are to be communicated to provider/clinic team immediately.
• Reviews and identifies new treatment orders.
• Communicates openly and routinely throughout the course of the workday with various teams such as the Financial Counselor Team, Intake Team, UM team, and coworkers through Teams, phone calls, emails, and in person to discuss items as needed to complete managed care.
• Works closely with outside entities to ensure full collaboration and completion of forms and items needed in a timely and sometimes urgent manner.
• Understands and complies with all Federal and State laws and regulations pertaining to patient care, rights, safety, billing, and collections.
• Works overtime when given sufficient notice of required overtime.
• Keeps work area and records in a neat and orderly manner.
• Maintains all company equipment in a safe and working order.
• Adheres to all AON and departmental policies and procedures, including Revenue cycle policies and procedures.
• Performs other duties and projects as assigned.

Requirements

• High school Diploma or GED required; further education or degree a plus.
• A minimum of two years prior experience in the healthcare field, preferably in a clinical or business office setting.
• Prior experience with medical terminology, medical insurance verification, and verifying pre-certification and/or prior authorization with medical insurance.
• Excellent verbal and communication skills.
• Insurance knowledge requirements including an understanding of medical terminology, ICD-9, ICD-10, and CPT codes.
• Ability to calculate and collect patients’ responsibility and insurance co-pay/coinsurance.

Skills

• Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management, and organizational skills. Must be detail-oriented with the ability to exercise independent judgment.
• Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.
• Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation), active listening, and providing balanced feedback.
• Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness, and operational excellence through best practices, strong business and political acumen, collaboration, and partnerships, as well as positive employee, physician, and community relations.
• Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with the ability to work independently with limited supervision. Ability to work remotely effectively as required. Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.
• Computer Skills: Proficiency in MS Office Word, Excel, Power Point, and Outlook required. Ability to use multiple screens to perform required job functions. Ability to navigate multiple applications and tab in and out of workflow to complete tasks.

Pay

Pay Range: $18.93 - $31.56 per hour.

Schedule

Standard core workdays/hours: Monday to Friday, 8:00 AM – 5:00 PM.