Managed care coordinator in Pennington, NJ at DISYS

Date Posted: 9/25/2018

Job Snapshot

Job Description

TITLE                        -  Care coordinator


LOCATION               -  Pennington, NJ


CONTRACT              -  6 months


 


Job Description:


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.



•        Handles initial screening for pre-certification 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 clinical review.



•        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.



•        Perform other relevant tasks as assigned by Management.



Qualifications:


Education:



•        High School Diploma required.



•        Some College preferred.


Work experience:



•        Prefer 1-2 years customer service or medical support related position.


Specialized knowledge/skills:



•        Requires knowledge of medical terminology



•        Requires Good Oral and Written Communication skills



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



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



•        Prefer knowledge Managed Care principles



•        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

Job Requirements


TITLE                        -  Care coordinator


LOCATION               -  Pennington, NJ


CONTRACT              -  6 months


 


Job Description:


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.



•        Handles initial screening for pre-certification 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 clinical review.



•        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.



•        Perform other relevant tasks as assigned by Management.



Qualifications:


Education:



•        High School Diploma required.



•        Some College preferred.


Work experience:



•        Prefer 1-2 years customer service or medical support related position.


Specialized knowledge/skills:



•        Requires knowledge of medical terminology



•        Requires Good Oral and Written Communication skills



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



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



•        Prefer knowledge Managed Care principles



•        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


Digital Intelligence Systems, LLC. is an Equal Opportunity Employer, M/F/D/V. We do not discriminate against any employee or applicant because they inquired about, discussed, or disclosed compensation. Email recruitinghelp @ disys.com to contact us if you are an individual with a disability and require accommodation in the application process.