Managed Care Coordinator

About the role

A Managed Care Coordinator acts as the liaison between the Financial Counselor and the Utilization Management and Intake team, coordinating managed care reviews of benefits, authorizations and referrals. The role keeps patient insurance benefits current in the electronic medical records and billing software and verifies that services meet coverage criteria. It is based in Hawaii Cancer Care, with standard hours Monday to Friday, 8:00 AM to 5:00 PM.

Key responsibilities

• Monitor and coordinate with insurance companies on pre-certification and prior authorization, including peer-to-peer requests and appeals, with support from providers or pharmacists when needed.
• Review patient and physician schedules and treatment plans against payor guidelines and preferred treatments, flagging active coverage and unplanned exceptions to the provider or clinic team.
• Identify new treatment orders and communicate with the Financial Counselor, Intake and Utilization Management teams via Teams, phone, email and in person.
• Work with outside entities to complete forms and items in a timely way, and work overtime when given sufficient notice.
• Comply with federal and state laws on patient care, rights, safety, billing and collections, and follow AON and departmental policies, including revenue cycle procedures.

Required profile

• High school diploma or GED; further education or a degree is a plus.
• At least two years of prior healthcare experience, preferably in a clinical or business office setting.
• Proven experience verifying pre-certification and prior authorization with medical insurance, and medical insurance verification.
• Knowledge of medical terminology, ICD-9, ICD-10 and CPT codes, and ability to calculate patient responsibility, co-pay and coinsurance.
• Ability to work independently with limited supervision and to work remotely when required.

Required skills

• Proficiency in Microsoft Word, Excel, PowerPoint and Outlook.
• Ability to use multiple screens and switch between applications and tabs.
• Good command of English; second language is an asset.