Your Job Sumarmy

The Managed Care Intake Coordinator assists with all aspects of the managed care authorization process as well as assisting with the functions of the Case Management department.This includes but is not limited to reviewing verification of benefits for accuracy, completing verification of benefits as needed, receiving authorization requests with timely submission to MCO’s for authorizations, tracking and updating the status of authorizations with timely communications to department staff and OPCO’s skilled nursing facilities. This position is focused on supporting the role of the Case Management department in optimizing Regional Case Manager(s) efficiency and effectiveness while supporting the administrative functions of the Case Management department.

GENERAL DUTIES AND RESPONSIBILITIES:

·Assist with and/or complete managed care verification of benefits (VOB) as needed and assigned.

·Responsible for interpreting and understanding managed care insurance policy terms, guidelines, and limitations revealed during verification of benefits and outlined on VOB.

·Maintain clear and concise communication with facilities and Regional Case Managers, facilities and Accounts Receivable as needed, regarding upcoming changes in policy benefits, limitations or terminations noted during the VOB process that may compromise revenue. Including but not limited to copays, coinsurance, limited SNF days, max OOP, deductibles etc.

·Receive auth request packets from the regional case managers and initiate authorizations by phone, fax or using online portal(s).

·Assist the Regional Case Managers and Director of Case Management as needed with administrative duties associated with the managed care line of business.

·Maintain a managed care data base for MCO policy types, phone/fax numbers, third-party entities related to MCO benefit verification, authorizations, and claims processing.

·Maintain essential knowledge of all MCO portals for access to electronic benefit verification methods and authorization submissions.

QUALIFICATIONS:

·Minimum of 2 years’ experience working with managed care benefits verification

·Minimum of 2 years’ exposure to skilled nursing and long-term care line of business

·Advanced understanding of managed care insurance benefit terminology

·Excellent critical thinking skills and problem-solving skills

·Ability to effectively manage the general duties and responsibilities outlined above and as instructed, with many of those occurring at the same time throughout the day

·Ability to keep detailed records and ensure accurate information

·Excellent written and oral communication skills

·Proficient in Microsoft Office Suite, particularly Excel, Word and Outlook