Managed Care Coordinator

Location: Remote Position Hiring Range: $15.60 - $26.58 This position will be Work From Home - but qualified candidates must reside in Central Time or Eastern Time zones to be considered. Job Description Summary: A Managed Care Coordinator serves as the liaison between the Financial Counselor and the Utilization Management and Intake team by coordinating managed care review of benefits, authorizations, referrals and streamlining communication of the managed care components for patient services. Performs the quality control function for pre-certification and prior authorization. The Managed Care Coordinator ensures the patients’ insurance benefits are kept up to date in the electronic medical records (EMR) and billing software while also verifying the patient’s services meet coverage appropriateness. Primary Job Duties & Responsibilities: Monitors and coordinates internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals, seeking support from provider or pharmacy team when applicable. Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to evaluate coverage criteria with payor guidelines and preferred treatment. Review patients’ treatment plan(s) and identify if insurance benefit coverage is active, all unplanned exceptions are to be communicated to provider/clinic team immediately. Review and identify new treatment orders. Communicate openly and ro