Managed Care Coordinator in El Segundo, CA at Avanti Hospitals

Date Posted: 7/3/2019

Job Snapshot

Job Description

Avanti Hospitals, Corporate Office

Job Title: Managed Care Coordinator 

City: El Segundo / State: California    

Managed Care

Day Shift

From 8:00 AM

To 4:30 PM

                                      


Job Description and Job Responsibilites

Job Title: Managed Care Coordinator

Job Summary:

As a Managed Care Coordinator, you will handle a variety of operational issues needed to ensure the smooth communication between a medical facility, the insurance companies the facility participates with and the patients. While reporting to upper management, you will primarily be responsible for handling insurance claims, phone inquiries, and mail in a professional and timely manner. Works with Directors and Managers on Letter of Agreements, Contracting, and Credentialing activities for the Managed Care Department. Reports to Managed Care Manager.

Essential Job Duties:

 Demonstrates knowledge of all Managed Care State and Federal regulations and updates.

 Responsible for handling of day to day mail, insurance claims, phone inquiries, in a timely manner.

 Assist third-party agencies with a variety of inquires in a courteous and professional manner

 Access Health Plans portal to validate health coverage

 Review UB04 or CMS1500 to determine claim disposition (i.e. clean or unclean claim) and validate

  • Eligibility Verification
  • Benefit Coverage
  • Coordination of Benefits
  • Authorization status (Inpatient and Elective services), validate if AB1203 requirements were met for inpatient admissions
  • Proof of timely filling

 Review billed services to determine Division of Financial Responsibility

 Responsible for batching and mailing of claims 

 Responsible for ensuring checks are accounted for, signed and logged prior to distribution. Maintain Attestation Log up to date.

 Maintain tracking logs up to date (i.e. check registers, paid claims, LOA), to include inquiries, complaints, comments and outcomes. 

 Audit Paid Claims report for accuracy and flag duplicate or over payments

 Assist with Letter of Agreements, Contracting, and Credentialing activities as directed by Director or Manager.

 Demonstrates the ability to recognize and deal with priorities in order to complete work in a timely manner.

 Performs all other duties and projects as assigned

 

 Behavioral Standards:

 Exhibits customer and service oriented behaviors in every day work interactions.

 Demonstrates a courteous and respectful attitude to internal workforce and external customers.

 Communicates accurately and appropriately.

 Works well and efficiently under minimal supervision.

 Handles difficult situations in a discreet and professional manner.

 Is adaptable to changes in assignments and priorities. 

Communication/Knowledge:

 Provides accurate and timely written and verbal communication of information in a manner that is understood by all. 

 Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.

 Able to use IT systems in an accurate and proficient manner. 

Collaboration/Teamwork:

 Contributes toward effective, positive working relationships with internal and external colleagues.

 Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.




Job Requirements

Education/Experience:

 High school graduate or equivalent required

 At least 2 years of current experience in an acute care hospital setting preferred.

 Some knowledge of Managed Care

 Computer skills preferred 

Licensure/Certifications:

N/A

 

Job Requirements

Education/Experience:

 High school graduate or equivalent required

 At least 2 years of current experience in an acute care hospital setting preferred.

 Some knowledge of Managed Care

 Computer skills preferred 

Licensure/Certifications:

N/A