Managed Care Coordinator

Merakey • Philadelphia, PA

6d • $21 • Onsite

About The Position

We are currently seeking Managed Care Coordinator to join our Intellectual and Developmental Disabilities Services (IDD) division.

Requirements

• High school diploma, business school background preferred.
• Experience/training in a medical office/insurance company required.
• Must be familiar with the managed care field, computer literate or able to learn Microsoft Office.

Responsibilities

• Interface with physicians, AVS staff (Nurses, Adaptive Equipment Specialist, Motor Development Specialist, PT, OT, ST, & Administrators), Durable Medical Equipment vendors, pharmacy, etc. to obtain documentation, facilitate billing and coordinate follow-up.
• Communicate with family regarding insurance questions, issues, changes, etc.
• Complete, submit and track all letters of medical necessity, medical exceptions and other documentation, resubmissions, approvals, rejections and billing for physical/medical consults, therapies, durable medical equipment/supplies, and other services needed by the individuals and paid for by insurances.
• Coordinate referrals for physician, therapy services, testing and DME needs.
• Coordinate the appeals process on behalf of the physician, as needed.
• Contact area physicians and needed medical services to find those participating in the network.
• Respond to billing inquiries and work with providers, Fiscal, and family contacts, as needed, to obtain resolution.
• Maintain current client insurance information by working with Social Services, Fiscal, and family contacts.
• Establish and maintain various file systems, as directed.
• Travel to various AVS facilities to consult with the physician and AVS staff to retrieve information from charts, as needed.
• Attending Managed Care related meetings which minimally includes House Manager, Pharmacy and Therapeutics, Pre-admission, as well as regular meetings with the Health Services Supervisors to discuss any outstanding issues.
• Respond to insurance inquiries and provides required information and documentation.
• Perform related duties, special assignments, and projects, as required.

Benefits

• Comprehensive medical, dental, and vision coverage, plus access to healthcare advocacy support.
• Retirement plan -- both pre-tax and Roth (after-tax) options available for employee contributions.
• DailyPay -- access your pay when you need it!
• On the Goga well-being platform, featuring self-care tools and resources.
• Access Care.com for backup childcare, elder care, and household services.
• Confidential counseling, legal, and financial services through our Employee Assistance Program (EAP).
• Tuition reimbursement and educational partnerships.
• Employee discounts and savings programs on entertainment, travel, and lifestyle.
• Access to Pryor Online Learning for free online personal development classes.

What This Job Offers

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