Managed Care Coordinator

American Oncology Network•Urbana, IL

2d•$16 - $27•Remote

About The Position

The Managed Care Coordinator serves as a liaison between the Financial Counselor and the Utilization Management and Intake teams. The role coordinates managed care review of benefits, authorizations, referrals, and related communication for patient services. It also performs quality control for pre-certification and prior authorization, keeps patients’ insurance benefits current in electronic medical records (EMR) and billing software, and verifies that services meet coverage requirements. This is a work-from-home position. Candidates must reside in the Central or Eastern Time zone. The standard schedule is Monday to Friday, 8:00 AM–5:00 PM. Occasional overtime may be required, and weekend shifts may be needed based on location hours and operational needs. Travel is 0%.

Requirements

High school diploma or GED required.
At least two years of prior healthcare experience required, preferably in a clinical or business office setting.
Prior medical terminology experience.
Prior medical insurance verification experience.
Experience verifying pre-certification and/or prior authorization with medical insurance.
Proven verbal and written communication skills and a good command of English.
Insurance knowledge, including understanding medical terminology, ICD-9, ICD-10, and CPT codes.
Ability to calculate and collect patient responsibility and insurance copayments or coinsurance.
Critical-thinking, problem-solving, analytical, decision-making, planning, time-management, organizational, and detail-oriented skills; ability to exercise independent judgment.
Interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation, and diversity awareness; ability to handle sensitive and confidential information and emotionally charged matters.
Effective oral, written, and presentation communication skills; active listening and ability to provide balanced feedback.
Strong customer focus and ability to collaborate and build effective relationships with employees, physicians, and the community.
Ability to manage time, competing priorities, stress, and professional development; self-motivated, able to work independently with limited supervision and effectively work remotely.
Ability to work effectively in a fast-paced, multi-site environment and manage competing priorities and demands from various stakeholders and sites.
Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
Ability to use multiple screens and navigate multiple applications and workflows.
Must reside in the Central or Eastern Time zone.
Must be able to work the stated schedule; overtime may be required with sufficient notice, and weekend shifts may be required based on location hours and operational needs.

Nice To Haves

Further education or a degree is a plus.
A second language is an asset but is not required.

Responsibilities

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