CareFirst BlueCross BlueShield
Medical Management Coordinator I (Remote)
CareFirst BlueCross BlueShield, Baltimore, Maryland, United States, 21276
Medical Management Coordinator I (Remote)
Join to apply for the
Medical Management Coordinator I (Remote)
role at
CareFirst BlueCross BlueShield .
Essential Functions
Provides ongoing internal and external customer support for operational inquiries from members, providers and/or other customers including benefit verification, authorization creation and management, claims inquiries and/or case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity.
Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Screens and/or prioritizes members using targeted intervention business rules and processes to identify needed services and transitions to appropriate clinical resources/programs as required.
Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care processes and/or tracking of Peer-to-Peer reviews.
Qualifications Education Level:
High School Diploma or GED.
Experience:
3 years experience in a health care or health insurance setting.
Preferred Qualifications:
Previous experience in a health care/managed care setting or previous customer facing experience, especially in a medical management related department.
Knowledge, Skills And Abilities (KSAs):
Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Excellent communication, organizational and customer service skills.
Knowledge of basic medical terminology and concepts used in care management.
Knowledge of standardized processes and procedures for evaluating medical support operations business practices.
Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
Ability to pay attention to the minute details of a project or task.
Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.
Salary Range:
$38,520 - $70,620
Department:
Non-Clinical (Phones and Faxes)
Physical Demands:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Federal Disqualification/Physical Demand:
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Equal Employment Opportunity:
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply: Please visit our website to apply: www.carefirst.com/careers
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Medical Management Coordinator I (Remote)
role at
CareFirst BlueCross BlueShield .
Essential Functions
Provides ongoing internal and external customer support for operational inquiries from members, providers and/or other customers including benefit verification, authorization creation and management, claims inquiries and/or case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity.
Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Screens and/or prioritizes members using targeted intervention business rules and processes to identify needed services and transitions to appropriate clinical resources/programs as required.
Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care processes and/or tracking of Peer-to-Peer reviews.
Qualifications Education Level:
High School Diploma or GED.
Experience:
3 years experience in a health care or health insurance setting.
Preferred Qualifications:
Previous experience in a health care/managed care setting or previous customer facing experience, especially in a medical management related department.
Knowledge, Skills And Abilities (KSAs):
Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Excellent communication, organizational and customer service skills.
Knowledge of basic medical terminology and concepts used in care management.
Knowledge of standardized processes and procedures for evaluating medical support operations business practices.
Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
Ability to pay attention to the minute details of a project or task.
Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.
Salary Range:
$38,520 - $70,620
Department:
Non-Clinical (Phones and Faxes)
Physical Demands:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Federal Disqualification/Physical Demand:
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Equal Employment Opportunity:
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply: Please visit our website to apply: www.carefirst.com/careers
#J-18808-Ljbffr