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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:
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Authorization, coordination, fulfillment, reporting, monitoring and tracking of services covered by the plan
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Verify health insurance coverage through ePaces and case management system
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Responds to inquiries from members and providers regarding health insurance, benefits, eligibility and authorization
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Ensures that all authorizations are completed accurately and efficiently in a timely manner
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Initiates contact with case management team, provider relations department and external providers to meet member’s needs and support departmental business initiatives
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Documents, tracks and follows up with case management team for all member service requests. Provides support to Case Management team
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Maintains and supports documentation, logs and data entry to monitor activity and/or outcomes related to Medicare billable services
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Refers members to case management or other clinical programs as indicated
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Back-up to the Member Service department and offer coverage/assistance as needed
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Conducts all work in accordance with the confidentiality requirement mandated by HIPPA for member information
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Reports any member dissatisfaction and grievance as appropriate
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Participates in special projects and perform other duties as assigned
Requirements/Qualification:
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Minimum formal education of High School Diploma
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Minimum 3 years job-related experience in healthcare/medical setting
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Strong ability to solve problems independently and interact with an integrated team
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Excellent communication and customer service skills
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Strong multi-tasking abilities
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Bilingual in Spanish, Russian, Chinese(Cantonese/Mandarin) is preferred
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Additional Information:
https://chc.tbe.taleo.net/chc01/ats/careers/v2/viewRequisition?org=VILLCARE&cws=39&rid=1521
Posted on 04.07.17
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