CareCentrix

Care Coordinator

Job Locations US-CT-Hartford
Job ID
2018-5223

Overview

The Care Coordinator is responsible for tracking and monitoring turnaround times to assure service requirements are met. The coordinator will participate in the collection and documentation of all required data to management an episode of care for end to end. This will data entry to the appropriate clinical database, generate reports and do analysis to maintain the clinical program’s goals.

 

Responsibilities

• Intake management for referral sources for the entry into a clinical program.
• Involved in the collection, verification and confirmation or non-clinical information.
• Completes the initial set up of a case or request for services and refers to the Payer Fact Sheets to determine if the terms of the contract are covered.
• Manage incoming and outbound calls to support the clinical program.
• Tracking and management of production queues.
• Maintains the data to high quality standards. Analyzes data from the database. Runs reports from the database.
• Understands that timely and accurate documentation is critical to the success of CareCentrix.
• Assures that notification of a determination is timely within contractual and regulatory turnaround times including oral notification and letters generated and mailed.
• Works with operations departments, clinical, quality and correspondence departments to assure accuracy and timeliness processing from end to end.
• Work with the clinical team to prepare forms, and other necessary documentation for delivery to MD offices and external providers to secure clinical information needed to plan and implement the clinical program obligations.
• Gathers structured clinical documentation.
• Is able to provide non-clinical issue resolution and escalation of an issue to management when appropriate.
• Contacts referral sources as needed to advise them of their of their referral status and facilitates referral information to the appropriate clinical program associate.
• Leverages review decision tools where appropriate to automate utilization management review.
• Participates in and contributes to performance and process improvement activities.
• Ability to negotiate with providers when needed and stay within the guidelines.
• Must be committed to quality and high standards.
• Participates in implementing/maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
• Must perform other duties as required or assigned.

Qualifications

• High School Diploma or the equivalent plus a minimum of one year medical terminology or medical services experience required.
• Minimum of two years insurance, quality improvement or healthcare operations required.
• Must have knowledge of basic spreadsheet, word processing, and data entry skills.
• Must be proficient and comfortable in a computer based environment.
• Experience in a call center environment preferred.
• Knowledge of Utilization Management and URAC standards preferred.
• This position requires excellent communication, customer and problem solving skills, as well as the ability to interact with all levels of management and a highly diverse clientele.
• Must have strong organizational skills and be able to effectively manage and prioritize tasks.
• Embraces the values of accountability, consistency, engagement, empowerment, respect and outstanding service.

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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