Part Time Clinical Administrative Coordinator

About the position Responsibilities • Review claims for duplicates, denials, and referrals, ensuring claims information matches appropriate authorization. • Prepare cases for Medical Directors, UM Nurses, and Case Managers for clinical review. • Provide expertise in claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims. • Act as a resource for trainers and new hires on benefits, contract interpretations, exclusions, eligibility, and workflows. • Assist with escalated issues and maintain prompt turnaround time on all claims, handling priority claims within 24 hours. • Meet department quality and accuracy standards. • Interface with other departments to obtain necessary information for claims resolution. • Take ownership of the total work process and provide constructive feedback to minimize problems and increase customer satisfaction. • Ensure documentation is completed in appropriate systems. • Prepare and monitor MCR inventory reports to ensure adherence to turnaround time requirements. Requirements • High School diploma/GED • 2+ years of related managed care experience in Prior Authorization or Claim Review healthcare, and/or customer service • 1+ years in the healthcare industry • Knowledge of medical terminology, ICD-9, and CPT • Proficiency with Microsoft Office applications • Proficient with Medicare processing guidelines and working knowledge of medical contracts • Ability to work any of the 8-hour shift schedules during normal business hours of 7:00 am - 4:00 pm. Nice-to-haves • Ability to organize, prioritize, and communicate effectively. • Ability to provide excellent customer service to a varied customer base. • Ability to navigate multiple systems. • Ability to work in a fast-paced environment. Benefits • Comprehensive benefits package • Career development opportunities • Flexible work environment with hybrid options Apply tot his job