Managed Care Coordinator - Florida Medical Clinic
Dade City, FL
About the Job
Our Vision is to be the best choice for healthcare in our community
This posting is for a FULL-TIME Managed Care Coordinator within our Family Practice office in Dade City. This role is responsible for assisting providers, supervisors, and staff members with all aspects of the managed care plans. Qualified candidates must have a strong understanding of Medicare insurances and Excel spreadsheets, medical terminology. Five years of experience in a similar role preferred. Medical Assistant background a plus.
WHAT DOES FLORIDA MEDICAL CLINIC ORLANDO HEALTH HAVE TO OFFER ITS EMPLOYEES?
We offer a wide choice of compensation and benefit programs that are among the best. From competitive salaries to retirement plans. We make every effort to take care of the people who make our company great.
Gives you an employer that you will have pride in working for
Provides excellent training programs and opportunities for growth
Offers Medical Benefits including:
Employer Contributions to HSA high deductible plan
Discounts at our medical facilities
Cigna Open Access OAPIN & OAP plans
Supports Incentive based Wellness Programs
Offers company sponsored Life Insurance with buy-up provisions
Provides Dental, Vision, Long and Short Term Disability, Accident & Illness policy options
Supports Paid Time Off and Holidays
Gives generous 401K plan with annual 3% Employer contribution after one year of employment
Values and appreciates its employees
Boasts a reputation for superior health care and quality service
Job Qualifications:
High school graduate or GED
Strong customer service orientation
Time management and multitasking
Organize and manage multiple priorities
Computer proficiencies
Strong team player
Maintains MRA data as required by Managed Care Carriers
Reviews and completes managed care report; suspect, Hedis , Prostar.
Updates the Plan Code Audit for center
Normal physical ability; able to sit for long periods
Normal concentration and normal complexity of decision making
High level verbal and written communication skills
Keys to Success in this Role:
Essential Functions of the Position:
Acts as Case Manager
Obtains approval from the provider for requested authorizations
Coordinates visits
Notifies patients of the appointments
Forwards clinical data to the treating provider and/or facility
Notifies specialist office and patient of denied requests for authorization
Uses approved web tools to obtain authorizations
Reviews hospital census daily and distributes information to supervisors
Coordinates admissions with providers and facilities
Assists with coordination of care for patient
Assist in managing care for Out of State patients
Assists with complicated referrals for Home Health, DME and denials
Physician Staff Support
Train new providers on play polices, MRA, Hedis.
Updates providers and staff on changes in referral process, MRA and Part D coverage.
Inputs providers into Practice Management.
Works with supervisors and staff to promote team work.
Maintains MRA data as required by Managed Care Carriers
Submits claim encounters
Reviews and completes managed care reports; suspect, Hedis reports and updates Estar.
Addresses and handles all tasks in a timely manner
Coordinates meetings between providers/Medical Directors
Prepares agenda
Types minutes of meetings
Follows through on all requests by providers.
Provides reports to CFO (center totals, membership)
Handles and returns referral related calls
Additional Responsibilities:
Maintains an organized and clean work area
Participates in maintenance of office supplies
Performs other incidental and related duties as required and assigned
Physical and Mental Demands:
Routine desk and office activities
Ability to move frequently throughout the facility and to sit for long periods of time
High level verbal and written communication skills
Above average ability to manage multiple tasks and projects simultaneously
#IND123
We are an Equal Opportunity Employer and make employment decisions without regard to race, gender, disability or protected veteran status
Florida Medical Clinic Orlando Health is a drug-free workplace and maintains a policy in which new hires will be required to submit to pre-employment drug testing. This policy is intended to comply with applicable laws regarding drug testing and any privacy rights
