Doctors HealthCare Plans, Inc Hiring for Medical Management Coordinator at Coral Gables, FL Full Time

• Point of contact for providers regarding medical/behavioral/behavior/clinical services of benefits. Including (e-g notification, authorization).
• Extract and review fax requests for medical or clinical services requests.
• Receive calls requesting medical/clinical services or benefits information, respond to and transfer calls to appropriate individuals, warm transfer if applicable.
• Gather information to understand requests based on urgency.
• Follow protocols to task requests appropriately by checking procedure codes against notification requirements and benefit coverage to determine next steps.
• Take calls and questions from providers regarding case status and provide/explain authorization information to providers.
• Determine whether authorizations are required for requested medical services.
• Reference tools to research relevant rules, regulations or procedures.
• Enter requests to relevant system as needed.

Qualifications:

• Bilingual: English/Spanish preferred
• 2 years + experience preferred
• Proficient with computers
• Excellent organizational skills

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted.

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP

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