Position Summary:  Provides assistance to care managers and members in Village Care coordinating services.  Authorizes services based on plan of care and ensures that services are initiated and delivered in a timely manner.  Assists members with troubleshooting when service issues arise, or changes in service providers are requested.

Key Responsibilities:

  • Authorization, coordination, fulfillment, reporting, monitoring and tracking of services covered by the plan

  • Verify health insurance coverage through ePaces and case management system

  • Responds to inquiries from members and providers regarding health insurance, benefits, eligibility and authorization

  • Ensures that all authorizations are completed accurately and efficiently in a timely manner

  • Initiates contact with case management team, provider relations department and external providers to meet member’s needs and support departmental business initiatives

  • Documents, tracks and follows up with case management team for all member service requests. Provides support to Case Management team

  • Maintains and supports documentation, logs and data entry to monitor activity and/or outcomes related to Medicare billable services

  • Refers members to case management or other clinical programs as indicated

  • Back-up to the Member Service department and offer coverage/assistance as needed

  • Conducts all work in accordance with the confidentiality requirement mandated by HIPPA for member information

  • Reports any member dissatisfaction and grievance as appropriate

  • Participates in special projects and perform other duties as assigned

Requirements/Qualification:

  • Minimum formal education of High School Diploma

  • Minimum 3 years job-related experience in healthcare/medical setting

  • Strong ability to solve problems independently and interact with an integrated team

  • Excellent communication and customer service skills

  • Strong multi-tasking abilities

  • Bilingual in Spanish, Russian, Chinese(Cantonese/Mandarin) is preferred