Managed Care Authorization Coordinator

TITLE: MANAGED CARE COORDINATOR

REPORTS TO: REVENUE MANAGER

RESPONSIBILITIES:

· Processes insurance authorizations/reauthorizations. Serves as a liaison between BVNA clinicians and third party case managers.

· Performs data entry of following and /or similar information into BVNA’s Netsmart software program and/or third party insurer systems:

• Patient demographic information
• Physician information
• Referral source information
• Insurance information
• Authorization/reauthorization information
• Disciplines/services requested

· Inputs data into Netsmart and prints appropriate forms. Processes updates and notifies third party insurers of changes.

· Reviews patient’s medical record and extracts accurate, pertinent information. Submits that information to third party Case Managers for authorization/reauthorization purposes.

· Updates Netsmart with authorization/reauthorization. Sends ‘task’ to provider when indicated.

· Responds to internal/external inquiries regarding authorizations/reauthorizations.

· Maintains records as appropriate.

· Maintains open communications with all parties (internal and external) throughout the continuum of care process. Demonstrates effective communication skills, utilizing the appropriate chain of command.

· Maintains high performance standards and serves as a role model to peers.

· Attends team and BVNA meetings. May serve on BVNA committees.

· May recommend changes/revisions to his/her Manager.

· Performs similar or related duties as assigned.

QUALIFICATIONS:

· High school diploma: Associates Degree in Business or equivalent preferred

· Two to three years related experience and/or training; or equivalent combination of education and experience.
· Possesses an up-to-date knowledge of third party payors, i.e., Medicare, Medicaid, Blue Cross Blue Shield, private insurances and managed care products

· Knowledge of medical terminology

· Clerical/secretarial/administrative skills

· Home health care experience preferred

· Ability to establish professional relationships and to communicate positively and effectively with others he/she interacts with in the course of job performance

· Positive, respectful attitude and excellent customer service skills.

· Computer literacy (EMR, Word, Outlook).

We are an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected veteran status, or any other characteristic protected by federal, state, or local law.

· Ability to work independently and problem solve

For a complete job description please visit our website at www.brocktonvna.org

Job Type: Full-time

Pay: From $24.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• 403(b) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Work Location: In person