Supports coordination of medical services including care management intake, health screening, and provider requests to promote effective utilization of healthcare services. Promotes and supports care managers and utilization management team as required.
RESPONSIBILITIES/TASKS:
Provides support services to team members by answering incoming telephone calls, taking messages, researching information, and assisting in solving problems to include assisting members with basic benefit and program information.
Completes member health screenings to identify needed services and completes member referrals in accordance to benefit plan.
Assists care managers as needed to mail member letters, contact provider offices, arrange provider appointments and transportation, and other duties as necessary.
Responsible for initial review and triage of care team tasks to include reason for admission, facility, and member program to correctly apply intervention assessment tools.
Monitors member admissions, enters discharge dates and disposition, refers to needed services in accordance to benefit plan.
Performs non-medical research pertinent to the establishment, maintenance, and closure of member cases to include the research and resolution of claims issues.
Maintains accurate and complete documentation of required information that meets quality standards
Protects the confidentiality of the member information and adheres to the company policies regarding confidentiality.
Performs other duties as assigned.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION:
High school diploma or G.E.D. required. Associate's or Bachelor's degree in health care related field is preferred. Current unrestricted LPN license or certified Medical Assistant designation preferred.
EXPERIENCE:
Minimum of one year experience in a health care related field. Preferred setting is hospital, medical doctor's office, or health insurance company. Experience with medical terminology and concepts used in the healthcare delivery system, provider office, or the insurance industry is required.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Computer literacy to include Microsoft Office products, and internal systems to include JIVA, IKA Systems, and Symphony
Advanced technical skills for use of hardware and software with a high degree of accuracy.
Excellent oral and written communication skills for representation of clear and concise results.
Ability to manage significant workload, and to work efficiently under pressure, meeting established deadlines with minimal supervision.
Strong time management skills.
Must possess high degree of accuracy, efficiency, and dependability.
Strong customer service skills to assist members and/or providers with understanding healthcare information and to coordinate issue resolution.
Effective written and verbal communication and feedback.
Effective organizational skills with ability to be flexible and prioritize tasks.
Knowledge of educational assessments and learning strategies.
Must be knowledgeable of and able to use standard, basic grammar, punctuation, and spelling.
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
PAY RANGE:
"Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $57,400 and $96,200."
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
