Managed Care Coordinator

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Title: Managed Care Coordinator

Duration: 5+ Months

Location: Newark NJ


Additional Skills: -
Strong
knowledge of claims processing required.

Job Summary:

This
position supports the Health Services and Utilization Management functions and
acts as a liaison between Members, Physicians, Delegates, Operational Business
members and Member Service Coordinators.


Responsibilities: - Performs review of service
requests for completeness of information, collection and transfer of
non-clinical data, and acquisition of structured clinical data from
physicians/patients.- Performs a thorough analysis of claims to determine the
correct course of action and takes the necessary steps to resolve - Handles
requests from physicians/members via incoming calls or correspondence based on
scripts and workflows, and under the oversight of clinical staff. - Prepare,
document and route cases in appropriate system for review or claims
adjustments. - Initiates call backs and correspondence to members and providers
to coordinate and clarify benefits. - Upon completion of inquiries initiate
call back or correspondence to Physicians/Members to coordinate/clarify case
completion. - Reviewing professional medical/claim policy related issues or
claims in pending status. - Upon collection of clinical and non-clinical
information MCC can authorize services based upon scripts or algorithms used
for pre-review screening.


Job Description:


*Non
Clinical staff members are not responsible for conducting any UM review
activities that require interpretation of clinical information. - Perform other
relevant tasks as assigned by Management.



Core Individual Contributor Competencies:

Personal
and professional attributes that are critical to successful performance for
Individual Contributors: Customer Focus Accountable Learn Communicate



Qualifications: Education: -

High
School Diploma required. Some College preferred.

Work experience: -

Prefers
2-3 years claims processing/investigations experience.

Specialized knowledge/skills: - 
 

• Requires knowledge of medical terminology


• Requires knowledge of a claims processing platform with
  health insurance carrier (i.e., FACETS, QBLUE, etc.)


• Requires Good Oral and Written Communication skills


• Requires ability to make sound decisions under the direction
  of Supervisor


• Prefer knowledge of benefit contracts, enrollment, billing
  & claims coding/processing


• Prefer knowledge Managed Care principles and/or Medicaid


• Prefer the ability to analyze and resolve problems with
  minimal supervision


• Prefer the ability to use a personal computer and applicable
  software and systems Team Player, Strong Analytical, Interpersonal Skills

If you are not interested in looking at
new opportunities at this time I fully understand. I would in that case be
appreciative of any referrals you could provide from your network of friends
and colleagues in the industry. We do offer a referral bonus that I’d be happy
to extend to you if they turn out to be a great fit for my client.

We do have referral bonus of $500 per candidate, if you refer any of your friends or colleague who are looking out for the same job.
 

thanks

Deepak

732-844-8717