Eden Prairie, United States
11 months ago
The Behavioral Operations Support Team Care Coordinator position is a fast-paced position that includes numerous tasks including, but not limited to:
Create and process Administrative and Medical Necessity determination denial letters to facilities and members ensuring accuracy with documentation and compliancy with state and federal guidelines for multiple lines of business including CAMS, TruCare, CCMS, and QANI.
Partner with internal matrix teams to ensure legal, Federal and State Mandates are in compliance and NCQA & URAC accreditation guidelines are met.
Responsible for tracking and sending Lack of Information letter requests.
Utilize Excel, Daily Stats, and Sharepoint site to create and send out morning report, which details case assignment and caseloads for case managers.
Complete monthly reporting and stats.
In control of managing the precert bin and assigning cases to case managers and care coordinators in an expeditious manner.
Accountable for the TruCare provider add process.
Integrate with other Care Coordinator teams to support and reinforce the day to day needs.
Additional tasks and reports as assigned.