Detailed Job Description:          

Title: Managed Care Coordinator

Location: Pennington, New Jersey 08534

Duration: 6+ Months         

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 the appropriate system for clinical review. 
• Initiates callbacks 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 on scripts or algorithms used for pre-review screening. 
• Non-Clinical staff members are not responsible for conducting any UM review activities that require the interpretation of clinical information. 
• Perform other relevant tasks as assigned by Management. 

Required Skills: 

• Requires knowledge of medical terminology. 

Desired Skills: 

• Prefer 1-2 years of customer service or medical support-related position. 
• Prefer knowledge of contracts, enrollment, billing & claims coding/processing. 
• Prefer knowledge of 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

Education:  

• High School Diploma required. 
• Some College preferred.