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    Managed Care Coordinator - Wilmington, United States - Wilmington Health

    Wilmington Health
    Wilmington Health Wilmington, United States

    Found in: Talent US C2 - 4 days ago

    Default job background
    Accrues PDO
    Description

    Purpose:

    Processes all referral forms and answers all patient and employee questions regarding previously requested authorization

    Essential Duties/Responsibilities:

    Processes all authorizations requiring prior approval from the managed care company.

    Enters all authorization numbers into Experior.

    Faxes all referral forms to specialists.

    Files all referral forms.

    Answers all incoming calls referred to their respective number.

    Takes messages, orders charts when necessary and relays messages in a timely fashion (does not triage).

    Screens patient calls, provides requested information, or refers to appropriate department.

    Assists all WH clinical staff on a daily basis with any managed care questions.

    Returns all Email in prompt manner.

    Communicates with insurance companies.

    Communicates with specialist's offices.

    Attends clinical staff meetings and other meetings as required by the department managers.

    Maintains patient confidentiality.

    Arranges seminars and educational meetings with WH clinical staff and physicians.

    Works on special projects as required.

    Works with Business Office account representatives on claims follow-up and re-filing;

    Other Duties:

    As assigned by manager

    Qualifications:

    Required:

    High school diploma, GED, or high school equivalency

    3 to 5 years' experience in a medical office environment;

    or equivalent combination of education and experience.

    Preferred:

    Managed Care Coordinator Competencies

    General

  • Customer Service
  • Professionalism/Integrity/Responsibility
  • Teamwork/Process Focus
  • Dependability/Punctuality
  • Interpersonal Relationships/Communication
  • Judgment/Decision Making/Problem Solving
  • Quality/Quantity
  • Initiative
  • Safety/Housekeeping
  • Organizational Skills/Time Management

    • Department Specific

  • Processes all pre-certs and prior authorizations within 48 hours for evaluate and treats.
  • Processes all surgeries and procedures five days prior to appointment.
  • Completes all retro requests within five days.
  • Processes all mail and correspondence on a daily basis.
  • Copies monthly Medicaid enrollment for all locations by the fifth of each month.
  • Maintains up-to-date information re: managed care plans. Distributes necessary updates to staff/management.
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