Merakey·Philadelphia, Pennsylvania
The Managed Care Coordinator facilitates billing, coordinates referrals, and manages documentation for medical services and equipment. They also serve as a primary point of contact for families and providers regarding insurance inquiries and network participation.
We are currently seeking Managed Care Coordinator to join our Intellectual and Developmental Disabilities Services (IDD) division.
Interface with physicians, AVS staff (Nurses, Adaptive Equipment Specialist, Motor Development Specialist, PT, OT, ST, & Administrators), Durable Medical Equipment vendors, pharmacy, etc. to obtain documentation, facilitate billing and coordinate follow-up.
Communicate with family regarding insurance questions, issues, changes, etc.
Complete, submit and track all letters of medical necessity, medical exceptions and other documentation, resubmissions, approvals, rejections and billing for physical/medical consults, therapies, durable medical equipment/supplies, and other services needed by the individuals and paid for by insurances.
Coordinate referrals for physician, therapy services, testing and DME needs.
Coordinate the appeals process on behalf of the physician, as needed.
Contact area physicians and needed medical services to find those participating in the network.
Respond to billing inquiries and work with providers, Fiscal, and family contacts, as needed, to obtain resolution.
Maintain current client insurance information by working with Social Services, Fiscal, and family contacts.
Establish and maintain various file systems, as directed.
Travel to various AVS facilities to consult with the physician and AVS staff to retrieve information from charts, as needed.
Attending Managed Care related meetings which minimally includes House Manager, Pharmacy and Therapeutics, Pre-admission, as well as regular meetings with the Health Services Supervisors to discuss any outstanding issues.
Respond to insurance inquiries and provides required information and documentation.
Perform related duties, special assignments, and projects, as required.
Earn $21.00/hour in this position.
Learn more about our full benefits package - https://www.merakey.org/careers/benefits [https://www.merakey.org/careers/benefits]
Merakey is a non-profit provider of developmental, behavioral health, and education services. More than 8,000 employees provide support to nearly 40,000 individuals and families throughout 12 states across the country each year. Click here to watch a video about Merakey. [https://youtu.be/MD3KtxmS7qo] Merakey strictly follows a zero-tolerance policy for abuse.
Merakey is proud to be an Equal Opportunity Employer! We deeply value diversity and do not discriminate on the basis of race, religion, color, national origin, ethnic background, sex, gender, gender identity, sexual orientation, age, marital status, veteran status, genetic information, or disability status. Moreover, we are committed to creating teams that reflect the diversity of the communities we serve and encourage applicants from underrepresented backgrounds to apply. Merakey welcomes all Veterans to apply!
Candidates must have a high school diploma and experience or training in a medical office or insurance company. Familiarity with the managed care field and proficiency in Microsoft Office are required.
Market context
Physician openings in Pennsylvania are often driven by ongoing clinical coverage needs and specialty demand, so competition can be strongest for roles that require board eligibility, Pennsylvania licensure or IMLC eligibility, and preferred fellowship or EPIC experience. Benefits and requirements on this platform are AI-summarized from the original job description, helping you review the key details faster. If you are considering applying, confirm your licensure path and highlight any EPIC or fellowship experience in your materials.