Managed care Coordinator in Pennington, NJ at DISYS

Date Posted: 10/8/2018

Job Snapshot

  • Employee Type:
    Contractor
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/8/2018

Job Description

Title                         - Managed Care Coordinator

Location                 - Pennington, NJ

Position Type        - 6 Month Contract

Job Description:

Roles & 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. *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: - 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, enrolment, billing & claims coding/processing - Prefer knowledge Managed Care principles - Prefer the ability to analyse 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                         - Managed Care Coordinator

Location                 - Pennington, NJ

Position Type        - 6 Month Contract

Job Description:

Roles & 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. *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: - 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, enrolment, billing & claims coding/processing - Prefer knowledge Managed Care principles - Prefer the ability to analyse 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.