Healthcare Claims Coordinator

Cynet Systems • Baltimore, MD

5d

About The Position

The Healthcare Claims Coordinator supports Utilization Management clinical teams by performing non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care. The role provides member- and provider-related administrative support, helps route and manage authorization requests, coordinates departmental services, and assists with information tracking and reporting.

Requirements

• High school diploma.
• At least 3 years of experience in healthcare claims, service areas, or office support.
• Ability to effectively participate in a multidisciplinary team with internal and external participants.
• Excellent communication, organizational, and customer service skills.
• Knowledge of basic medical terminology and concepts used in managed care.
• Knowledge of standardized processes and procedures for evaluating medical support operations business practices.
• Excellent independent judgment and decision-making skills, with tact and diplomacy.
• Strong attention to detail.
• Proficiency with web-based technology and Microsoft Office applications, including Word, Excel, and PowerPoint.

Nice To Haves

• Two years of experience in a healthcare or managed care setting.
• Knowledge of CPT and ICD-10 coding.
• Experience with GuidingCare and Facets.
• Proficiency with Lotus Notes, Nasco, SharePoint, PCMR, and CAU.

Responsibilities

• Perform member- or provider-related administrative support, including benefit verification, authorization creation and management, claims inquiries, and case documentation.
• Review authorization requests for initial determination or triage them for clinical review and resolution.
• Provide general departmental support and coordination, including answering telephone calls, managing correspondence, researching information, and assisting with problem resolution.
• Assist with reporting, data tracking, gathering, organization, and dissemination of information, including the Continuity of Care process and tracking peer-to-peer reviews.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED