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Job Title: Senior Coordinated Care Specialist
Job Location: NY: New York City
Pay Rate: Open
Job Length: full time
Start Date: 2008-09-05

Company Name: GHI
Contact: Recruiter
Phone: email only please
Fax: email only please

Description: Senior Coordinated Care Specialist COMPANY: GHI LOCATION: 34th Street

HOURS:

DEPT:

Description of Duties Processes benefit extension requests for a variety of outpatient products including physical, occupational, allergy, speech and orthoptic therapies. The Sr. CCS also provides pre • review screening for inpatient and ambulatory services. The Sr. CCS must ensure that all cases are processed in accordance with departmental policies and procedures, URAC, standards, Managed Care Law and Departmental of Labor Law regulations.

* Processes pre-review screening requests via the CCD call center for inpatient and ambulatory services * Analyzes and responds to treatment plan/claim inquiries regarding Coordinated Care Services and maintains daily/monthly production logs for Senior Management; assigns cases via the RightFax system * Responds to telephonic (via Benefit Extension call center) and written benefit plan inquiries requesting Benefit Extension services and processes request based on regulatory timeframes * Collaborates with physicians and other medical providers to collect and coordinate benefit plan determinations; coordinates cases with contractual arrangements, making appropriate recommendations and modifications for efficiency and effectiveness based on departmental policies and procedures * Investigates and validates subscribers? primary insurer, and if questionable, refers inquiry to the designated Coordinated Care Specialist for Coordination of Benefits (COB) verification * Reviews and obtains pertinent scripted medical information and applies appropriate guidelines for on-line determinations for benefit extensions which include, Physical Therapy, Occupational Therapy, Speech Therapy, Allergy care and Orthoptic Therapy.

Requirements Knowledge Skills & Abilities: * Proficient in hospital and medical mainframe * Ability to multitask and perform under stress * Flexible * Attention to detail * Excellent communication skills * In-depth knowledge of GHI medical and hospital contracts * Bachelors degree in Health Administration or related field preferred * Minimum of four (2 ) years of healthcare experience preferred * Minimum of one (1) year of experience working with medical providers preferred * Minimum of two (2) years experience as a Coordinated Care Specialist preferred * Proficiency in medical terminology, medical practices and claims processing preferred * Customer Service experience preferred

Please refer to Job code ghi-1672 when responding to this ad.

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