Managed Care Coordinator

2 weeks ago

Dade City, United States Florida Medical Clinic Full time

Our Vision is to be the best choice for healthcare in our community

This posting is for a FULL-TIME Managed Care Coordinator within our Family Practice office in Dade City. This role is responsible for assisting providers, supervisors, and staff members with all aspects of the managed care plans. Qualified candidates must have a strong understanding of Medicare insurances and Excel spreadsheets, medical terminology. Five years of experience in a similar role preferred. Medical Assistant background a plus.

WHAT DOES FLORIDA MEDICAL CLINIC ORLANDO HEALTH HAVE TO OFFER ITS EMPLOYEES?

We offer a wide choice of compensation and benefit programs that are among the best. From competitive salaries to retirement plans. We make every effort to take care of the people who make our company great.

Gives you an employer that you will have pride in working for

Provides excellent training programs and opportunities for growth

Offers Medical Benefits including:

Employer Contributions to HSA high deductible plan

Discounts at our medical facilities

Cigna Open Access OAPIN & OAP plans

Supports Incentive based Wellness Programs

Offers company sponsored Life Insurance with buy-up provisions

Provides Dental, Vision, Long and Short Term Disability, Accident & Illness policy options

Supports Paid Time Off and Holidays

Gives generous 401K plan with annual 3% Employer contribution after one year of employment

Values and appreciates its employees

Boasts a reputation for superior health care and quality service

Job Qualifications:

High school graduate or GED

Strong customer service orientation

Time management and multitasking

Organize and manage multiple priorities

Computer proficiencies

Strong team player

Maintains MRA data as required by Managed Care Carriers

Reviews and completes managed care report; suspect, Hedis , Prostar.

Updates the Plan Code Audit for center

Normal physical ability; able to sit for long periods

Normal concentration and normal complexity of decision making

High level verbal and written communication skills

Keys to Success in this Role:

Essential Functions of the Position:

Acts as Case Manager

Obtains approval from the provider for requested authorizations

Coordinates visits

Notifies patients of the appointments

Forwards clinical data to the treating provider and/or facility

Notifies specialist office and patient of denied requests for authorization

Uses approved web tools to obtain authorizations

Reviews hospital census daily and distributes information to supervisors

Coordinates admissions with providers and facilities

Assists with coordination of care for patient

Assist in managing care for Out of State patients

Assists with complicated referrals for Home Health, DME and denials

Physician Staff Support

Train new providers on play polices, MRA, Hedis.

Updates providers and staff on changes in referral process, MRA and Part D coverage.

Inputs providers into Practice Management.

Works with supervisors and staff to promote team work.

Maintains MRA data as required by Managed Care Carriers

Submits claim encounters

Reviews and completes managed care reports; suspect, Hedis reports and updates Estar.

Addresses and handles all tasks in a timely manner

Coordinates meetings between providers/Medical Directors

Prepares agenda

Types minutes of meetings

Follows through on all requests by providers.

Provides reports to CFO (center totals, membership)

Handles and returns referral related calls

Additional Responsibilities:

Maintains an organized and clean work area

Participates in maintenance of office supplies

Performs other incidental and related duties as required and assigned

Physical and Mental Demands:

Routine desk and office activities

Ability to move frequently throughout the facility and to sit for long periods of time

High level verbal and written communication skills

Above average ability to manage multiple tasks and projects simultaneously

We are an Equal Opportunity Employer and make employment decisions without regard to race, gender, disability or protected veteran status

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