The Medical Management Care Coordinator collects specific data in the medical management information system for the clinical staff while also resolving authorization issues as well as troubleshooting, researching and resolving related issues in a timely and efficient manner.
- Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools
- Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication
- Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved
- Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions
- Provides triage and management of calls ensuring that established call performance targets are consistently achieved
High School degree or equivalent required.
Minimum of two years of experience in a customer service role required. Excellent oral and written communication skills required. Advanced personal computer skills, including Word, Excel or Access required. Utilization Management experience preferred.
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