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Healthcare Management Support Coordinator

Company: Allied National, LLC (Overland Park, KS)
Location: Kansas City
Posted on: April 9, 2021

Job Description:

Allied National is seeking a Case Management Support Coordinator to assist Case Managers in reviewing medical records to triage and determine the cases requiring clinical review to join our growing Healthcare Management (HCM) Department.

Essential Functions:

Demonstrate knowledge of claims procedures, telephone equipment, and procedures of the pre-certification process and any policy exclusions associated with the plan administered. Review and Interpret received.

Respond to appeals from insureds and providers on a timely basis, using established guidelines and requirements and the involvement of external peer review companies as needed.

Keep Supervisor informed of all potential, and actual high dollar cases, appeals, problems with external vendors, backlogs in the workflow, and other requests he/she deems are needed.

Be available to explain HCM's utilization and management process to practitioners, vendors, providers, and/or patients.

Marginal Functions:
Be available as a resource to HCM, Claims, Marketing, Underwriting, Customer Service departments, and management.

Be available to explain HCM's utilization and management process to practitioners, vendors, providers, and/or patients.

May perform one or more of the following functions:


  • Review external case management vendor invoices for accuracy;
  • Provide training on the case management and precertification
  • Review and interpret complex medical records or reports for Claims Analysts.
  • Assist in maintaining state utilization review licenses as needed.

    PM21

    • College graduate with Medical Record Clerk, Billing Clerk, or LPN background/experience
    • One to five years of healthcare experience with extensive medical terminology knowledge.
    • One to three years experience in managed care, indemnity case management, third-party administration (TPA), clinical loss projection, medical underwriting, or utilization management preferred.
    • Previous working knowledge of Nationally Recognized Criteria (i.e., InterQual or MCG).
    • Knowledge of medical care costs preferred.
    • Ability to speak English fluently. Ability to read, comprehend, and follow written or verbal English instructions.
    • Excellent telephone communication skills (i.e., listening for understanding, responding accurately, professionally, and expressing self in an assertive but positive manner, ability to control the call, etc.).
    • Demonstrated skills in multi-tasking, critical thinking, problem-solving, prioritizing, and organization
    • Ability to perform basic math skills and operate a calculator and computer.
    • Ability to compose proper business correspondence (i.e., letters, memos, and file documentation).
    • Ability to sit or stand for 7.5 hours per day and use copiers, scanners, printers, etc.
    • Ability to meet company attendance requirements.
    • Ability to achieve and maintain training standards and department quality and production standards.
    • Ability to work under and handle the stress associated with varying workloads, deadlines, and handling a high volume of calls.
    • Ability to travel occasionally to outside vendors, seminars, etc.
    • Ability to meet established criteria and qualify for professional licensing and liability insurance.
    • Maintain active nursing licensure in the state of Kansas.
    • Allied National is one of the nation's oldest and most experienced third-party administrators. We strive to be the first choice for level-funded group health benefit products for small and mid-sized employers. We work hard to exceed agents, employers, and members' expectations through fast, friendly service. We operate in a team atmosphere utilizing personal and peer group expertise to deliver high-touch, high-value service to our clients.

Keywords: Allied National, LLC (Overland Park, KS), Kansas City , Healthcare Management Support Coordinator, Healthcare , Kansas City, Kansas

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