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Healthcare Coordination Specialist
2 months ago
General Overview:
The Managed Care Coordinator at MetaSense Inc. plays a pivotal role in bridging communication between our organization, insurance providers, and patients. This position is essential for ensuring that medical services receive the necessary approvals and that all regulatory standards are adhered to. Additionally, the coordinator is responsible for the management of health records and the accurate documentation of all services and requests.
Key Responsibilities:
- Oversee utilization reviews of managed care agreements following established protocols.
- Ensure compliance of all clinical operations with Medicare, Medicaid, and other managed care regulations.
- Liaise with healthcare providers, discharge planners, and others to facilitate referrals and service authorizations, while capturing relevant utilization data.
- Coordinate referrals and authorizations to enhance the health outcomes of patients.
- Manage denials related to medical necessity, authorization issues, and insufficient clinical information.
- Facilitate communication with insurance companies.
- Ensure timely delivery of clinical information to insurance carriers.
- Review all incoming communications via fax, email, or mail on a daily basis.
- Collaborate with the Business Office and Admissions Department to ensure updates are reflected in payer systems.
- Organize Sub-Acute Discharge meetings in conjunction with the Nursing, Social Services, Rehabilitation, and Business Office departments.
- Execute special managed care initiatives; conduct independent research and compile information for reports and data summaries.
- Assist other departments with projects as necessary to promote teamwork.
- Perform additional duties as assigned.
Essential Skills and Experience:
- A minimum of two (2) years of experience in health management or a related field.
- Strong relationship-building capabilities.
- Excellent interpersonal and verbal communication skills.
- Highly organized with the ability to work independently on projects.
- Detail-oriented with a commitment to follow-through.
- Exceptional writing, listening, and problem-solving abilities.
- Proficient in Microsoft Office applications, including Word and Excel.
Educational Requirements:
- Bachelor's Degree in Nursing is required.
Preferred Qualifications:
- A Master's Degree is highly preferred.
Licensure and Certifications:
- A valid New York State Registered Nursing license is required.
