Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)
Responsibilities:
Patient Benefit Verification Information: Ensures accurate completion of benefit verification of all new patient insurance information and authorization in accordance with State and Federal regulations, individual requirements and Hospital policies and procedures.
Insurance Referral & Authorization Requirements: Responsible for obtaining required authorizations and/or referrals for all new outpatients scheduled by OP intake coordinators and physician admins for existing and new outpatient program visits
Patient Financial Responsibility: Reviews/obtains insurance co-payment information from third party payers for accuracy. Communicates co-payment and deductible information to Outpatient Receptionists, PBO and Patients.
Requirements:
Education: High School Diploma
Training and Experience: Benefit verification 2 to 4 years exp,
Special Qualifications: Systems: Epic, Cerner preferred but not required
Applicants MUST have strong knowledge and experience with insurance benefit interpretation, interacting with insurance companies, etc.
Schedule: Per Diem Union position
Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status
Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.
Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.