Managed Care Coordinator

A Managed Care Coordinator serves as the liaison between the Financial Counselor and the Utilization Management and Intake team by coordinating managed care review of benefits, authorizations, referrals and streamlining communication of the managed care components for patient services. Performs the quality control function for pre-certification and prior authorization. The Managed Care Coordinator ensures the patients’ insurance benefits are kept up to date in the electronic medical records (EMR) and billing software while also verifying the patient’s services meet coverage appropriateness.

Proficiency in MS Office Word, Excel, Power Point, and Outlook required.

Ability to use multiple screens to perform required job functions.

Ability to navigate multiple applications and tab in and out of workflow to complete tasks.

Travel :   0%

Standard Core Workdays/Hours: Monday to Friday 8:00 AM – 5:00 PM. 

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• Monitors and coordinates internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals, seeking support from provider or pharmacy team when applicable.

• Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to evaluate coverage criteria with payor guidelines and preferred treatment.

• Review patients’ treatment plan(s) and identify if insurance benefit coverage is active, all unplanned exceptions are to be communicated to provider/clinic team immediately.

• Review and identify new treatment orders.

• Communicate openly and routinely throughout the course of the workday with various teams such as the Financial Counselor Team, Intake Team, UM team and coworkers through Teams, phone calls, emails and in person to discuss items as needed to complete managed cares.

• Work closely with outside entities to ensure full collaboration and completion of forms and items needed in a timely and sometimes urgent manner.

• Understand and comply with all Federal and State laws and regulations pertaining to patient care, rights, safety, billing, and collections.

• Will be expected to work overtime when given sufficient notice of required overtime.

• Keep work area and records in a neat and orderly manner.

• Maintain all company equipment in a safe and working order.

• Adhere to all AON and departmental policies and procedures, including Revenue cycle policies and procedures.

• Performs other duties and projects as assigned.