Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.

POSITION SUMMARY:

Reports to the Supervisor, Care Mgmt and under general supervision coordinate and manage the referral and/or authorization process in accordance with benefit contract guidelines and criteria. Ensures customer satisfaction by providing timely and accurate information when responding to customer inquiries, utilizing good judgment in triaging and documenting customer calls. Participates in the daily operations of
the department which may include processing authorizations, participation in resolving claims related issues, assisting with internal and external mail, filing and other administrative duties assigned.

REQUIREMENTS:

Education:

• A minimum of a high school diploma or GED is required.

Knowledge:

• Requires knowledge of the referral and authorization process as well as the daily
• activities of an intake unit.
• Requires an understanding of managed care
• Basic Knowledge of ICD-9 diagnosis and CPT coding.
• Requires knowledge of behavioral health and medical terminology.

Required Licensure, Certification, Etc.:

• Care Management Program Certification Preferred.

Work Experience:

• A minimum of 1- 2 years providing administrative or intake support in a managed care management or customer service department preferred.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.