Job Details

What are the day to day responsibilities? Outbound calls, emails, and processing of unable to contact requests.

Duties and Responsibilities:
• Provides support to the Case Management staff performing non clinical activities and supporting the management of the department.
• Responsible for initial review and triage of Case Management tasks.
• Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan.
• Screens members using policies and processes assisting clinical Case Management staff as they identify appropriate medical services
• Coordinates required services in accordance with member benefit plan.
• Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members).
• Runs reports to assist in coordination of case management needs.
• Provides support services to case management team members by answering telephone calls, taking messages and researching information.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Protects the confidentiality of member information and adheres to company

Knowledge, Skills and Abilities:
• Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity
to concerns, proactive identification and resolution of issues to promote positive outcomes for members
• Demonstrated ability to communicate, problem solve, and work effectively with people
• Working knowledge of medical terminology and abbreviations
• Ability to think analytically and to problem solve.
• Good interpersonal/team skills
• Must have a high regard for confidential information
• Ability to work in a fast paced environment
• Able to work independently and as part of a team.
• PC experience in Windows environment and accurate data entry at 40 WPM minimum.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members,
providers and customers

Required Education:
High School Diploma or G.E.D.

Required Experience:
Two or more years experience as a medical assistant,
office assistant or other healthcare service administrative
support role.