Job Details

Managed Care Coordinator | 2 Years of Experience | Hopewell, NJ | Hybrid | Contract

Walker Healthforce is seeking a Managed Care Coordinator with 2 Years of Experience to support a Healthcare Payer Client based out of New Jersey. This is a 6 month Contract opportunity.

RATE RANGE: $18 - 21 Hourly
HOURS/SCHEDULE: Monday-Friday 8:30am-5pm EST
WORKER TYPE: W2

CORE REQUIREMENTS:

• 1-2 years customer service or medical support related position.
• Exposure to Utilization Management functions
• High volume Call Center experience / Strong verbal and written communication
• High School Diploma required. Some College preferred.

ADDITIONAL REQUIREMENTS:

• Requires knowledge of medical terminology
• Requires ability to make sound decisions under the direction of Supervisor

WE CONSIDER IT A BONUS IF YOU ALSO HAVE:

• Knowledge of contracts, enrollment, billing & claims coding/processing
• 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
• Prior Healthcare experience preferred.

JOB RESPONSIBILITIES:

• This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.
• Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
• Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
• 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.
• Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion.
• Reviewing professional medical/claim policy related issues or claims in pending status.
• Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening. *Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information.

WHAT WE OFFER:

• Competitive compensation package
• Weekly pay via Direct Deposit
• Medical, Dental & Vision available
• 401k options

WHY WORK WITH WALKER?

• Access to our top ranked team of recruiting and placement specialists
• Continuous, one-on-one support from a dedicated engagement manager
• Professional resume development and interview preparation

Contact our Recruiting Team today to experience the Walker Healthforce difference!

ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we're custom not commodity and we've been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.