Managed Care Coordinator

Job not on LinkedIn

🕒 2 days ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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

• Performs review of service requests for completeness of information • Collection and transfer of non-clinical data • Acquisition of structured clinical data from physicians/patients • Prepare, document and route cases in appropriate system for clinical review • Initiates call backs and correspondence to members and providers to coordinate and clarify benefits • Reviewing professional medical/claim policy related issues or claims in pending status • Acts as liaison with providers, members and Care Managers • Handles initial screening for pre-certification requests from physicians/members • Assists members with finding providers, resolving problems and answering questions regarding anything from how to obtain services to how to file an appeal • Makes outbound calls to engage members in Case Management • Educates members regarding preventive health activities and services • Triage and distribute referrals from Member Services and incoming faxes from providers

🎯 Requirements

• High School Diploma/GED required • Prefer 1-2 years customer service or medical support related position • Requires knowledge of medical terminology • Requires Good Oral and Written Communication skills • Requires ability to make sound decisions under the direction of Supervisor • Prefer knowledge of contracts, enrollment, billing & claims coding/processing • Prefer knowledge Managed Care principles • 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