Clinical Coordinator

Brooklyn NY 11201

Job Description

This position is responsible for providing assistance with the resolution of authorization and/or claim issues in various work queues resulting from and calls taken from facilities and providers. Acts as liaison between providers, internal departments and specific accounts, clients, and claims department.

Essential Functions



- Resolves cases in queue due to member eligibility issues, referring provider verification or request, imaging provider verification, redirection, and retro reviews. Assists with authorization problem resolution through research and facilitating the resolution of the problem in a timely fashion.
- Process, forward, trend, and maintain records of authorization issues. Acts as a troubleshooter to resolve problems among internal departments.
- Handles special requests from Customers requiring manual workarounds or specials projects.
- Investigates written/verbal complaints involving authorizations, and resolves complex issues with Customers and Providers.
- Assists specific accounts who have special processes.
- Observes and tracks authorization problem trends and works with internal department for resolution.
- Assists with User Acceptance Testing (UAT).
- Provides phone back-up coverage for other teams as needed.

General Job Information

Title

Clinical Coordinator

Grade

18

Job Family

Customer Service Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

7/9/2018

Date Requisition Created

7/9/2018

Minimum Qualifications

Education

A Combination of Education and Work Experience May Be Considered.||&& Bachelors

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Ability to review and interpret multiple contract/account information to successfully resolve issues regarding benefit plan administration; experience with account benefit structures.
  • Demonstrated ability for problem solving, meeting deadlines, initiative and follow-through.
  • Excellent written and verbal communication skills.
  • Knowledge of pharmacy benefits management.
  • Understanding of customer service performance metrics (ASA, abandonment rate, talk time).

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

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