PROVIDER NETWORK MANAGER jobs in Orlando, FL

CASE MANAGER / CARE COORDINATOR - NEEDED ASAP

Excellent Opportunity at a Growing Company!

Bring your authorizations, insurance or benefits investigation, care coordinator, pre-certification and/or insurance skills to an innovative, team-oriented, healthcare hub services company! Join our friendly and supportive team and make a positive difference! Seeking people with excellent experience in/with pharmacy, health insurance, hubs, medical billing, and/or medical doctor’s offices as we continue to grow!

Qualifications:

• 1-3 years' experience in the medical/healthcare or insurance field (i.e. pharmacy, doctor's office, hospital admin., hub services, health plan member services, etc.), required.
• 1-3 years' experience with prior authorizations and/or pre-certifications for prescriptions, treatments, procedures and/or DME, preferred.
• Familiarity with medical billing, insurance verifications, reimbursement issues, a plus.
• Experience interacting with MDOs, insurance companies and/or pharmacies, preferred.
• Oncology, urology, orthopedic, pain management, or physical therapy related experience, a plus.
• Ability to maintain strict HIPAA patient confidentiality and protecting PHI.
• Strong computer skills including MS Office. Adaptable and eager to learn. Open to cross-training to build on experience.

Direct hire, full-time, onsite opportunity at our corporate headquarters in Maitland, FL.

We care about the safety and well-being of our team. We are mindful of safety precautions, following local government and CDC guidelines. Our office has plenty of space and sizable cubicles with room to grow!

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

CASE MANAGER

Essential Functions:

• Assists in facilitating the completion of authorizations for, or in combination with the MDO.
• Connects via phone with the MDO regarding clinicals, authorizations, transfers and/or follow-ups.
• Handles benefits request investigations submitted by MDOs (medical doctors’ offices).
• Contacts insurance companies directly to obtain information on a patient’s medical benefits, specialty pharmacy benefits and/or prescription benefits, where applicable.
• Contacts and follows up with MDOs, pharmacies and other facilities to assist with coordination of care for medication or treatment, as needed.
• Serves as a primary contact for inbound calls, answers inquiries regarding submitted cases, follow-ups and other case related issues, assisting the MDOs.
• Communicates with field access managers and key account managers on a regular basis for updates, support and to help ensure program needs are being met, where applicable. Communicates with and assists sales representatives, as needed.
• Documents and makes notations in the system regarding the case information.

Hours:
Monday-Friday, commonly needed shifts are 9:30 AM-6:00 PM, 10:30 AM-7:00 PM, or 11:30 AM - 8:00 PM. Other shifts may be available between 8:00 AM and 8:00 PM, for full-time hours, based on team needs.

Compensation:

Starting from $23.00 per hour. Higher rates may be considered for excellent candidates! Offer based upon experience, education, and interview process.

Please apply with us today to learn more about an excellent opportunity!

Job Type: Full-time

Pay: From $20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Insurance verification: 1 year (Required)
• Medical billing: 1 year (Preferred)
• Prior Authorizations: 1 year (Required)

Work Location: In person