HS Coordinator (CM)

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.

ESSENTIAL DUTIES AND RESPONSIBILITIES

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

WORK EXPERIENCE

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

LANGUAGE SKILLS

Bilingual English/Spanish fluency.