HS Coordinator (CM)

Leon Medical Centers • Miami, FL

1d

About The Position

The Health Services Coordinator will support the Health Services Department in
achieving clinical quality and service objectives by providing administrative
support to the Care Management Department or facilitating the referrals and
authorizations process or the precertification and prior authorization process.

Requirements

• Minimum of one (1) year managed care experience preferred in referral and/or preauthorization's.
• Bilingual English/Spanish fluency.

Responsibilities

• Monitors incoming requests for timely processing as per Leon Health’s policies and procedures and CMS requirements.
• Processes provider referrals and pre-authorization request per Leon Health’s policy and procedures.
• Contacts providers to verify or clarify requests.
• Contacts member/member’s representative for oral notification if applicable.
• Contacts provider for oral notification if applicable.
• Contacts Network Operations for Letter of Agreements, when necessary
• Contacts Courier service when needed.
• Updates members’ files in the system as appropriate.
• Forwards potential case management candidates to the Care Management Department.
• Stays logged into the phone and medical management queues on a daily basis.
• Communicates with the provider scheduling department when necessary.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 251-500 employees