Managed Care Coordinator

Role Details

Summary of Responsibilities:

Provides administrative support to the managed care nurse team. Works with minimal supervision and is responsible for making an established range of decisions, escalating to Manager when necessary and updating Manager on a regular basis.

Position Responsibilities:

• Assist managed care nurse team in document management functions, including: processing incoming and outgoing faxes and mail, and scanning documents into the workflow system within required timeframes.

• Initiates and responds to member and provider inquiries in order to obtain medical information for concurrent inpatient hospitalizations reviews, preauthorization requests, claim reviews, as well as disability requests and return to work guidelines. Updates the claims and leave adminstration system accordingly.

• Assist in researching claims and prescription drug history and length of stay guidelines in support of case reviews by the managed care nurses.

• Completing and sending form letters as needed.

• Serves as back-up support to the Administrative Assistant, including: processing of department expenses, maintaing appeals database and preparation of responses, ordering supplies and equipment for the department and coordinating internal maintenance and service requests.

• Performs other duties as assigned by management.

• Maintains a working knowledge of medical terminology to interpret medical reports and bills. Keeps abreast of new medical procedures and terminology.

• Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality and protection of person information including, but not limited to, personal health informatino and personally identifiable information.

Selection Criteria:

• Demonstrated strong attention to detail with excellent organizaitonal skills. Must cite examples of organization and time management methods used to manage or prioritize workload demands.

• Proven examples from work experience of maintaining a high degree of accuracy associated with high volumes of work and/or multiple duties.

• Proven experience handling and maintaining confidential information and correspondence.

• Demonstrated excellent verbal and written communication skills with ability to convey information, verbally and in writing, to internal and external customers at all levels in a clear, accurate, focused and concise manner. Demonstrated ability to document procedures and activities in a manner that is understandable to others and prepared using a prescribed format. Verbal and written communications are to conform to proper rules of punctuation, grammar, diction and style.

• Familiarity with medical terminology or medical claim coding is required.

Work Setting:

• Works in an office setting and remains continuously in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings.

• Frequently moves around the office to access file cabinets, office machinery, etc. While accessing file cabinets, frequently uses upper extremities to reach by extending hand and/or arms in any direction.

• Requires visual acuity to read a variety of correspondence, reports and forms and to prepare and analyze data in an accurate, neat and thorough manner.

Educational Requirements:

• High school diploma or GED.

Computer Skills and Knowledge of Hardware & Software Required:

• Working knowledge of word processing and spreadsheet application.

Certifications & Licenses (i.e., Series 6 & 63, CPA, etc.):

• None required

Position Demands:

• Extended hours required during peak workloads or special projects.

Requisition ID: 2023-19244

External Company Name: Western & Southern Financial Group

Street: 400 BROADWAY

Western & Southern Financial Group provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.