Managed Care Coordinator

Contract: Pennington, New Jersey, US

Salary: $20.00 Per Hour

Job Code: 334661

End Date: 2023-05-27

Job Status: Expired

This Job is no longer accepting applications

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


  • High School Diploma required. 
  • Some College preferred. 
Job Requirement
  • Billing & Claims Coding/Processing
  • Medical Terminology
  • Admin Assistant
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  • Harinarayan Waghmare
This Job is no longer accepting applications
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