About Wilmington Health

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.

Purpose:

Processes all referral forms and answers all patient and employee questions regarding previously requested authorization

Essential Duties/Responsibilities:

• Processes all authorizations requiring prior approval from the managed care company
• Enters all authorization numbers into Experior
• Faxes all referral forms to specialists
• Files all referral forms
• Answers all incoming calls referred to their respective number
• Takes messages, orders charts when necessary and relays messages in a timely fashion (does not triage)
• Screens patient calls, provides requested information, or refers to appropriate department
• Assists all WH clinical staff on a daily basis with any managed care questions
• Returns all Email in prompt manner
• Communicates with insurance companies
• Communicates with specialist’s offices
• Attends clinical staff meetings and other meetings as required by the department managers
• Maintains patient confidentiality
• Arranges seminars and educational meetings with WH clinical staff and physicians
• Works on special projects as required
• Works with Business Office account representatives on claims follow-up and re-filing

Other Duties:

• As assigned by manager

QUALIFICATIONS

Required:

• High school diploma, GED, or high school equivalency
• 3 to 5 years' experience in a medical office environment
• (Or) equivalent combination of education and experience
• Full COVID 19 vaccination is required as a condition of employment for all position with Wilmington Health. Documentation is required prior to orientation.

Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees. We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran’s status, sexual preference, disability, genetic information or any other class protected under state or federal law.

Managed Care Coordinator Competencies

General

• Customer Service
• Professionalism/Integrity/Responsibility
• Teamwork/Process Focus
• Dependability/Punctuality
• Interpersonal Relationships/Communication
• Judgment/Decision Making/Problem Solving
• Quality/Quantity
• Initiative
• Safety/Housekeeping
• Organizational Skills/Time Management

Department Specific

• Processes all pre-certs and prior authorizations within 48 hours for evaluate and treats.
• Processes all surgeries and procedures five days prior to appointment.
• Completes all retro requests within five days.
• Processes all mail and correspondence on a daily basis.
• Copies monthly Medicaid enrollment for all locations by the fifth of each month.
• Maintains up-to-date information re: managed care plans. Distributes necessary updates to staff/management.