Vacancy expired!
Kelly Services is looking for temporary Managed Care Coordinators for well known nonprofit medical clinic in Marshfield, WI, who's mission is to enrich lives through accessible, affordable, compassionate heath care.
JOB SUMMARY:
The Managed Care Coordinator completes insurance managed care requirements and provides case management as needed for services performed in the inpatient, outpatient, Ambulatory Surgery Center and provider office settings. The Managed Care Coordinator obtains and provides insurance benefit information to patients and medical departments. The Managed Care Coordinator assists patients and providers with developing strategies for alternative options for non-covered services by communicating with the provider, patient, insurance carrier and Patient Assistance Counselor.
ESSENTIAL JOB FUNCTIONS:
1. Regular attendance is an essential requirement of the position.
2. Completes insurance managed care requirements ((i.e. prior authorization, pre-notification, pre-certification, etc.) when needed for services ordered and/or provided by the clinic's providers.
3. Monitors services requiring case management by reviewing medical records, patient appointments and communicating with patients, patient care providers and insurance companies to ensure specific coverage requirements are met.
4. Contacts patient when necessary to obtain insurance or any other care related information in order to complete managed care requirements.
5. Communicates with patients and patient care staff regarding insurance coverage limitations and/or requirements.
6. Assists patients, staff and outside providers as needed with appeals and requests for retrospective referrals and prior authorizations.
7. Notifies Hospital Utilization Review and/or Admitting offices of reviews completed for urgent, elective, uninsured/underinsured admissions and outpatient procedures that require discharge planning after admission.
8. Reviews Ambulatory Surgery Center (ASC) and Hospital surgery schedule(s) to verify Pre Admission Review application (PAR) existence, accuracy and completion. If necessary, notifies and obtains missing information from medical department.
9. Assists in coordination, training of PAR, education and communication of managed care requirements to patients, physicians and employees.
10. Refers under-insured/uninsured patients and/or point-of-service pre-payment required services to Patient Assistance Counselors.
11. May interview and counsel under-insured and uninsured patients in specialty care areas to determine financial eligibility healthcare coverage programs.
EDUCATION:
High school graduate or equivalent. Medical terminology required.
Preferred Education: Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program preferred.
Experience:
Minimum Experience Required: A minimum of three years experience in medical business office, health care setting or comparable experience required. Prior experience should include working with and obtaining insurance eligibility and benefit information.
