Managed Care Coordinator I at CLS Health PLLC

Webster, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Aug, 26

Salary

0.0

Posted On

12 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Care Coordination, Population Health, Value-Based Care, Medicare Advantage, HCC Coding, Quality Measures, EHR Systems, Microsoft Excel, HIPAA Compliance, NCQA Accreditation, Medical Coding, Patient Scheduling, Insurance Authorization, Medical Record Review, Communication, Organization

Industry

Hospitals and Health Care

Description

Description About CLS Health CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians! Job Overview: The Managed Care Coordinator I is responsible for coordinating and ensuring the delivery of high-quality, cost-effective healthcare services to members. This role involves working closely with healthcare providers, patients, and insurance companies to facilitate care, manage resources, and support the healthcare team in achieving optimal patient outcomes. Responsibilities: Ensure all clinical operations comply with Medicare and Medicaid guidelines and other manage care policies. Adhere to all state, accreditation standards and regulatory guidelines which include HIPAA guidelines and NCQA accreditation. Conduct outgoing calls to patients to arrange appointments. Make outgoing calls to pharmacies to confirm each patient’s medication adherence. Prepare charts for providers, highlighting managed care directives that need attention. Reviewing medical records and treatment plans to ensure they align with the guidelines and policies of the managed care organization. Communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Review ICD-9 and HCPCS codes to ensure accurate coding on claims. Verify CPT codes to determine if authorization is needed and distinguish between network and non-network providers. Submit attestation forms through insurance portals. Document confidential patient information, upholding the highest standards of privacy in accordance with HIPAA regulations. Submit documentation to address and close care gaps for patients via insurance portals. Benefits: 401(k) 401(k) matching Dental Insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance Requirements Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or related field preferred. 2+ years of healthcare experience in care coordination, population health, or value-based care. Knowledge of Medicare Advantage, HCC coding, and quality measures preferred. Experience with EHR systems and Microsoft Excel. Strong communication and organizational skills.

Responsibilities

The Managed Care Coordinator I ensures the delivery of high-quality, cost-effective healthcare by coordinating between providers, patients, and insurance companies. Key duties include managing clinical compliance with Medicare/Medicaid guidelines, processing authorizations, and closing care gaps via insurance portals.