Managed Care Coordinator II

Job not on LinkedIn

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $50.1k - $67.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Supports the Clinical Operations functions • Acts as a liaison between members, physicians, delegates, operational business members, and member service coordinators • Provides leadership and guidance to non-clinical team and handle escalated issues/problems • Performs review of service requests for completeness of information • Collects and transfers of non-clinical data, and acquires structured clinical data from physicians/patients • Prepares, documents, and routes cases in appropriate system for clinical review • Initiates call backs and correspondence to members and providers to coordinate and verify benefits and courses of treatment • Assists with on-boarding and training of newly hired Managed Care Coordinators I • Performs initial screening of precertification requests from physicians/members received via incoming calls or correspondence using established scripts and workflows under the oversight of clinical/supervisory staff • Assists members with finding providers, resolving problems, and answering questions

🎯 Requirements

• High School Diploma/GED required • 3-5 years customer service experience • Requires knowledge of medical terminology • Requires good oral and written communication skills • Prefer knowledge of contracts, enrollment, billing & claims coding/processing • Prefer knowledge of Managed Care principles • Requires operational knowledge of health care delivery systems and health insurance industry • Requires knowledge of NCQA accreditation standards as well as state and federal laws applicable to health plan appeals and grievances • Prefer the ability to analyze and resolve problems with minimal supervision • Prefer the ability to use a personal computer and applicable software and systems

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement