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Medical Coordinator

Please Note: The application deadline for this job has now passed.

Job Introduction

Evaluates preauthorization requests and claims, makes decisions on payment or denial of claims within preset limit. Coordinates patient care including verification of benefits, pre-authorization for procedures and steers care to network provider or negotiates fees for off network care.

Role Responsibility

  • Manages claim requests, notification, preauthorization and eligibility questions via phone and email from Member, Producers, Providers, Physicians or authorized third party for assigned region; handles within given deadline and service objectives.
  • Reviews claims against policy to determine coverage and exclusions, reads physician information and decides compensability; may request additional information such as medical records to assist in decision making.
  • Makes decision on need for second opinion, obtains and issues authorization.
  • Sends letters of authorization or denial and explanations of benefit depending on outcome of claim evaluation.
  • Coordinates benefits eligibility, co-pays, exclusions, and determines need for second opinions, Physician or facility referral, and need for admission for care.
  • Negotiates rates with physicians or third parties outside the network utilizing usual and customary rates for specific country to ensure cost effectiveness of treatment.
  • Schedules appointments for Policy holders coming to the United States for treatment or Doctor’s appointment.
  • Evaluates patient condition and verifies that criteria required is met for air transfer, obtains authorization and coordinates air transfer if needed.
  • Enters notes for every conversation, email and decision in the system so that it is available company wide.
  • Performs follow up calls after procedure to determine if further care is needed.
  • May perform other functions as assigned by Regional Director or Medical Director.

The Ideal Candidate

  • 4 year College Degree preferred or relevant experience.
  • Minimum 4 years experience with Medical billing, coding and terminology.
  • Solid 2-3 years experience in Health Insurance Claims Service area with demonstrated experience in claims processing.
  • Previous experience1-2 years in customer service preferred.
  • Bilingual Spanish/English, fluently read, write and speak both languages.


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