Medical Management Coordinator

Tasks

• Assist analyst with triaging and entering appeals.
• Print and assist with medical records request and create overturn notices.
• Assist with creating shell cases in GuidingCare and create appeal letters.
• Screen all channels daily, return misroutes, confirm member/claim data, and queue clean cases oldest-first.
• Issue and track both requests on a fixed cadence, call provider offices on day 3, and index documents in GuidingCare. Only non-responsive providers escalate.
• Prepare MD and IRO packets and track vendor due dates.
• Route decisions, generate and mail letters and FFRNs, monitor the adjustment queue, and notify providers the day the decision is made.

Requirements

• Must have experience with GuidingCare and FACETS (Legacy and G6)
• Good to have LotusNotes and NASCO.
• The candidate must come from a Healthcare Claims / Appeals / UM background.
• Knowledge of CPT and ICD-10 coding.
• Minimum 2 years’experience in health care/managed care setting or previous work experience within division
• Knowledge of CPT and ICD-10 coding, previous appeals, ability to review letter of appeal, identify claims. Nasco is a plus.

Schedule

• Contract
• Hybrid

How to apply

• Contact me for further details.

Location

• Baltimore, MD