MLTSS Managed Care Coordinator I

MLTSS Managed Care Coordinator I

Requirements

• High School Diploma/GED required.
• Requires knowledge of medical terminology

Responsibilities

• Performs review of managed long term support and services requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physician/member
• 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 appropriate system for clinical review.
• Initiates call backs and correspondence to members and providers to coordinate and clarify managed long term support and services
• 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.
• MCC can generate an authorization for services based upon clinical staff review. *Non Clinical staff members are not responsible for conducting any UM review activities.*
• Member mailings
• Perform other relevant tasks as assigned by Management.

Preferred Qualifications

• Prefer 1-2 years customer service or medical support related position.
• Prefer knowledge of contracts, enrollment, billing & claims coding/processing
• Prefer knowledge Managed Care principles
• Prefer experience with the elderly frail or Managed Medicaid population
• Prefer the ability to analyze and resolve problems with minimal supervision
• Prefer the ability to use a personal computer and applicable software
• Team player, strong analytical, interpersonal skills