Employment - Job Descriptions

JOB TITLE:	Managed Care Coordinator
REPORTS TO:	Business Office Manager
FLSA STATUS:	Non-exempt
JOB OVERVIEW:	Acts as a liaison between members, providers, health plans and clinic staff to ensure coordination of managed care requirements.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

1. Facilitate incoming phone calls from members, providers and health plan representatives in a professional and courteous manner.
2. Coordinate The Doctors Clinic referral activities:

Intake referral requests
Data entry of all referrals into the Managed Care module
Verify member eligibility and benefits for requested referrals
Ensure that referrals are directed to contracted providers and are completed with all required information
Extract and print daily referral listing
Provide initial triage screening of referrals prior to submitting to the Medical Director for approval
Complete referral in the Managed Care module
Print and distribute referral forms and associated information to appropriate parties; i.e., members, providers, specialists, PCP and health plans

3. Participate in education of physicians and clinic staff related to managed care contracts, benefit changes and referral process.
4. Maintain accurate member registration, eligibility and billing information.
5. Coordinate First Step OB’s between Health Department and Physician.
6. Work with members and physicians on areas of concern related to benefits clarification.
7. Act as liaison between health plans and clinic regarding changes related to benefits and contracts, etc.
8. Act as liaison between health plan and physician regarding patient complaints and patient non-compliance.
9. Facilitate patient account inquiries regarding referrals and benefits.

ADDITIONAL RESPONSIBILITIES:

1. Prioritize work received and complete in a timely manner.
2. Assist other office personnel in the performance of their duties as assigned and as workload permits.
3. Maintain confidentiality of sensitive information.
4. Participate in meetings to put forth ideas and provide insight from own work perspective.
5. Work as a team member within the business office and all other departments.
6. Document work processes as required.
7. Perform other duties as assigned.

QUALIFICATIONS:

Education:
1. High school diploma or equivalent.
Certification/Licensure: Not required

Experience:
1. Minimum 3 years experience in a health care organization required.
2. Minimum 2 years experience in Managed Care preferred.

Skills:
1. Ability to communicate in the English language in person, by phone and in writing in a clear, concise and professional manner.
2. Ability to resolve problems with minimal assistance.
3. Ability to utilize sound judgment in making and implementing corrective action.
4. Medical terminology required.
5. Basic computer and keyboarding skills.
6. Strong organizational and interpersonal skills.
7. Experience with conflict management.
8. Excellent verbal communication skills. Ability to independently write correspondence appropriate for mailing to patients and insurance companies or other third parties.
9. Ability to professionally represent the clinic’s interests and patient concerns with parties outside of the clinic setting.
10. Ability to provide leadership to groups.

Other Requirements:
1. Ability to multi-task efficiently and effectively.
2. Must possess knowledge of coding and clinical operating policies and procedures.
3. Must be able to prepare and examine documents for accuracy and completeness, correcting errors.
4. Must be able to act calmly and effectively in a busy or stressful situation.
5. Requires adherence to all policies and procedures, including standards for safety, attendance, punctuality and personal appearance.
6. Must be able to establish and maintain effective working relationships with managers and peers.

Physical Requirements:
HHearing: Adequate to perform job duties in person and over the telephone.
Speaking: Must be able to communicate clearly in person and over the telephone.
Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens for long periods of time without eye strain or stress.

Other: Requires sitting for extended periods of time. Requires manual dexterity to operate office equipment. Requires frequent bending, reaching, repetitive hand movements, standing, walking and squatting, with some lifting, pushing and pulling exerted regularly throughout a regular work shift.

THE DOCTORS CLINIC IS AN EQUAL OPPORTUNITY EMPLOYER

Last update: 5/16/2002