What are the responsibilities and job description for the Admin/Clerical - Managed Care Coordinator position at Alpha Business Solutions?
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. - 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, 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
We offer a competitive compensation package that includes :
Note : Pay rate will be commensurate with experience.
Salary : $18
