Managed Care Coordinator

American Oncology Network•Honolulu, HI

2d•$21 - $29•Onsite

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 reviews of benefits, authorizations, and referrals, and streamlines communication about managed care components of patient services. It performs quality control for pre-certification and prior authorization, keeps patients’ insurance benefits up to date in the electronic medical records (EMR) and billing software, and verifies that services meet coverage requirements. The coordinator works with insurance companies and internal teams to review upcoming visits and treatments, evaluate coverage criteria, review treatment plans and new orders, and address exceptions. The role also collaborates with outside entities to complete required forms and other items promptly, including when matters are urgent. The position is based at Hawaii Cancer Care; the posting identifies it as onsite and lists standard workdays of Monday through Friday, 8:00 a.m. to 5:00 p.m.

Requirements

High school diploma or GED required.
At least two years of prior experience in the healthcare field required, preferably in a clinical or business office setting.
Prior medical terminology experience.
Prior medical insurance verification experience.
Prior experience verifying pre-certification and/or prior authorization with medical insurance.
Strong verbal and communication skills.
Insurance knowledge, including understanding medical terminology and ICD-9, ICD-10, and CPT codes.
Ability to calculate and collect patient responsibility and insurance copayments or coinsurance.
Strong critical thinking, problem-solving, analysis, decision-making, planning, time-management, organizational, and attention-to-detail skills; ability to exercise independent judgment.
Interpersonal effectiveness, emotional intelligence, diplomacy, tact, conflict management, delegation, and diversity awareness; ability to handle sensitive and confidential information and emotionally charged matters.
Good command of English and effective oral, written, and presentation communication skills; active listening and balanced feedback skills.
Strong customer focus and ability to collaborate with teams, partners, 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 able to work remotely effectively when required.
Ability to work in a fast-paced, multi-site environment and manage competing priorities and demands from multiple stakeholders and sites.
Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
Ability to use multiple screens and navigate multiple applications while completing tasks.

Nice To Haves

Further education or a degree.
A second language.

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 treatments and evaluate coverage criteria against payer guidelines and preferred treatment.
Review patients’ treatment plans and verify that insurance benefit coverage is active; promptly communicate unplanned exceptions 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 through Teams, phone, email, and in-person discussions as needed.
Work with outside entities to complete forms and other required items in a timely manner, including urgent requests.
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 working order.
Follow AON and departmental policies and procedures, including revenue cycle policies and procedures.
Work overtime when given sufficient notice that overtime is required.
Perform other duties and projects as assigned.