Medical Management Care Coordinator

What We Provide

• Referral bonus opportunities

• Generous paid time off (PTO), starting at20daysof paid time offand 9 company holidays

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life andDisability

• Employer-matched retirement saving funds

• Personal and financial wellness programs

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

• Generous tuition reimbursement for qualifying degrees

• Opportunities for professional growth and career advancement

• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

• Interdisciplinary network of colleagues through the VNS Health Social Services Community ofProfessionals.

What You Will Do

• Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools.

• Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication.

• Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved.

• Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions.

• Provides triage and management of calls ensuring that established call performance targets are consistently achieved.

• Provides feedback to leadership regarding training needs

• Collaborates with management to determine the best approach to service customers, handle repeat vendor issues and other job-related matters to maximize and improve delivery, billing and payment of goods and services.

• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

• Participates in special projects and performs other duties as assigned.

Education:
High School Diploma or equivalent Required

Work Experience:
Minimum of two years of experience in a customer service role Required

Excellent oral and written communication skills Required

Advanced personal computer skills, including Word, Excel or Access Required

Utilization Management experience Preferred