CareCentrix

  • Home Care Coordinator

    Job Locations US-AZ-Phoenix
    Job ID
    2019-7044
    Category
    Clinical / Post Acute Care
  • Overview

    As a Care Coordinator you will be responsible for tracking and monitoring turnaround times to meet service requirements. You will participate in the collection and documentation of all required data to manage an episode of care from end to end.  You will enter data to the appropriate clinical database, generate reports and do analysis to maintain the clinical program's goals.

    Responsibilities

    • 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.
    • Intake management for referral sources for the entry into a clinical program.
    • Involved in the collection, verification and confirmation or non-clinical information.
    • 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.
    • Assures that notification of a determination is timely within contractual and regulatory turnaround times including oral
      notification and letters generated and mailed.
    • 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.
    • 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.
    • Ability to negotiate with providers when needed and stay within the guidelines.

    Qualifications

    • High School Diploma or the equivalent plus a minimum of 1 year medical terminology or medical services experience
    • 2 years in the insurance or healthcare industry, quality improvement or healthcare operations 
    • 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.


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