Medical management Coordinator
Iconma Portal•Baltimore, MD
•Hybrid
About The Position
The Medical Management Coordinator assists analysts with triaging and entering appeals. The role includes printing and assisting with medical-record requests, creating overturn notices, building shell cases in GuidingCare, and creating appeal letters. Coordinators support intake and case building, record retrieval, preparation of physician and IRO packets, and closure and notification activities.
Requirements
- Minimum 2 years of experience in a healthcare or managed-care setting, or previous work experience within the division.
- Knowledge of CPT and ICD-10 coding.
- Knowledge of claims.
- Experience with GuidingCare, Facets Legacy, and G6.
- Previous appeals experience.
- Ability to review a letter of appeal and identify claims.
Nice To Haves
- Knowledge of Nasco.
Responsibilities
- Screen all intake channels daily, return misrouted cases, confirm member and claim data, and queue clean cases oldest-first.
- Issue and track medical-record requests on a fixed cadence, call provider offices on day 3, and index documents in GuidingCare and SharePoint.
- Escalate only non-responsive providers.
- Prepare physician and IRO packets and track vendor due dates.
- Route decisions, generate and mail letters and FFRNs, monitor the adjustment queue, and notify providers on the day a decision is made.
- Assist analysts with triaging and entering appeals.
- Print and assist with medical-record requests, create overturn notices, create shell cases in GuidingCare, and create appeal letters.
Benefits
- Health benefits
- Referral program
- Growth and advancement opportunities
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
