Wizpro Inc Hiring for Medical Coder / Coordinator at Remote Full Time

Position Title: Medical Management Coordinator

Job Summary:

This position is responsible for triaging referral/authorizations intake, processing, providing support to the Medical Management department to ensure timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines. This position performs trouble-shooting when problems situations arise and takes independent action to resolve complex issues.

Responsibilities

· Input data into the Medical Management system to ensure timeliness of referral/authorization processing.

· Verifies member benefits and eligibility upon receipt of the treatment authorization request.

· Utilizes authorization matrix, ancillary rosters, and/or delegation agreements to drive decision-making.

· Coordinates with Medical Management Registered nurse for timely referral and prior authorization processing.

· Ensures timely provider and member oral and written notification of referral decisions.

· Ensures proper notification of patient facility admissions with PCP and NOMNC when applicable.

· Coordinates board certified Peer to Peer referrals with partner vendors.

· Coordinates and assists with patient appointments as needed and notify patient of authorization status.

· Performs trouble-shooting when problems situations arise; taking independent action to resolve complex issues.

· Performs coordination for out-of-network cases and facilitates letters of agreement (LOA) or Single Care Price Agreements (SCAs) processing in collaboration with Medical Management and Network designees and Leadership.

· Demonstrates excellent communications skills and interpersonal relationships.

· Collaborates and facilitates interdisciplinary team communications.

· Performs additional duties as assigned.

· Process referrals and/ or calls within the dept. targets based on workflows and technology.

· Meets inter-rater minimum standards for core responsibilities.

· If assigned to Provider Phone Queues, Collaborates with Customer Service Representatives to provide information regarding referral/authorization processing.

· Appropriately tracks incoming call types and pertinent details of calls

Job Type: Contract

Pay: $50.00 – $60.00 per hour

Experience:

• ICD-10: 1 year (Preferred)

Work Location: Remote