Managed Care Coordinator

American Oncology Network•Honolulu, HI

12h•Onsite

About The Position

The Managed Care Coordinator serves as a liaison between the Financial Counselor and the Utilization Management and Intake teams, coordinating managed care reviews of benefits, authorizations, referrals, and communication related to patient services. The role performs quality control for pre-certification and prior authorization, maintains current insurance benefits in electronic medical records (EMR) and billing software, and verifies that patient services meet coverage requirements. The coordinator works with internal teams and insurance companies to complete reviews, authorizations, peer-to-peer discussions, and appeals. The role reviews schedules, treatment plans, and new treatment orders against payer coverage criteria, communicates exceptions to provider and clinic teams, and collaborates with outside entities to complete required forms and items. The position also requires compliance with applicable laws, regulations, and company policies; orderly recordkeeping; and safe care of company equipment.

Requirements

High school diploma or GED.
At least two years of prior experience in the healthcare field.
Prior medical terminology knowledge.
Experience with medical insurance verification.
Experience verifying pre-certification and/or prior authorization with medical insurance.
Strong verbal and communication skills.
Insurance knowledge, including understanding of medical terminology and ICD-9, ICD-10, and CPT codes.
Ability to calculate and collect patient responsibility and insurance copayments or coinsurance.
Critical thinking, problem-solving, analysis, decision-making, planning, time-management, and organizational skills.
Attention to detail and ability to exercise independent judgment.
Interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, and diversity awareness.
Ability to handle sensitive and confidential material and emotionally charged matters effectively.
Good command of English and effective oral, written, and presentation communication skills.
Strong customer focus and ability to collaborate with stakeholders.
Ability to manage time, competing priorities, stress, and professional development; self-motivated and able to work independently with limited supervision.
Ability to work remotely effectively as required and manage competing demands in a fast-paced, multi-site environment.
Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
Ability to use multiple screens and navigate multiple applications and workflows.

Nice To Haves

Further education or a degree.
Healthcare experience in a clinical or business office setting.
A second language.

Responsibilities

Coordinate with insurance companies and internal teams on pre-certification and prior authorization processes, including peer-to-peer reviews and appeals, seeking provider or pharmacy team support when applicable.
Review assigned patients and/or physician schedules for upcoming visits or treatments and evaluate coverage criteria against payer guidelines and preferred treatment.
Review treatment plans and identify whether insurance benefit coverage is active; immediately communicate unplanned exceptions to the provider or clinic team.
Review and identify new treatment orders.
Communicate throughout the workday with the Financial Counselor, Intake, and Utilization Management teams and coworkers through Teams, phone, email, or in person to complete managed care tasks.
Collaborate with outside entities to complete required forms and items in a timely, sometimes urgent, manner.
Comply with federal and state laws and regulations related to patient care, rights, safety, billing, and collections.
Keep the work area and records neat and orderly.
Maintain company equipment in safe and working order.
Follow company and departmental policies and procedures, including Revenue Cycle policies and procedures.
Perform other duties and projects as assigned.
Work overtime when given sufficient notice that overtime is required.