Job Summary: Under minimal supervision and in a professional and friendly manner, perform assigned job duties to the highest level of customer service and assistance to both internal and external customers of Memorial Care Medical Foundations Inpatient/Specialty Services unit.
Duties & Responsibilities:
Provide customer services to external and internal clients
Review and update patient demographic information in EMR
Coverage for the HBAT telephone line and fax, scan and forward correspondence in a timely manner
Verify insurance coverage, benefit, eligibility and enrollment
Provide cross coverage for co-workers when needed for all assignments
Ensure accurate compliance of the authorization process
Review and update policies and procedures as workflow indicates
Provide customer service for patients, providers and facility staff. Respond to inquiries regarding pended charts, readmit data, admit and discharge dates, bed day and level of care for accurate authorizations. Independently research data for accuracy. Fax clinical correspondence as requested by Health Plan.
Provide coverage for the HBAT telephone line. Triage all calls and transfer accordingly. Send page to Hospitalist when indicated. Monitor right fax folder and convert, save, store and forward per determined work flow in a timely manner. Notify appropriate department or staff when time sensitive documents and orders are received.
Verify insurance coverage, benefit, eligibility and enrollment per determined workflow. Submit Help Desk tickets when indicated and track to completion. Report duplicate charts and update patient demographic information whenever indicated and verified.
Support Care Transitions Coordinators within the scope of practice and licensure.
Make follow up calls to Facilities, DME, Home Health agencies or Gerinet providers as requested by Care Management Team.
Ensure the authorization process adheres to stated turn-around times, are complete, faxed and received by all necessary parties. Ensure the appropriate and pertinent medical information accompanies the referral whenever indicated.
Assist Medical Management team with referral audits as requested by leadership. Review workflow and update policies and procedures when business needs change.
Attend seminars, training sessions, team huddles, case conference, Gallup committee and department meetings as requested by leadership.
Minimum of one year experience with HMO’s/Managed Care.
Knowledge of Utilization operations and prior medical office experience.
Must excel in interpersonal communication and customer service and be able to work both independently and as part of a team.
Must excel in organization and attention to details and follow through. Additionally, they must have the ability to problem solve to logical conclusion and demonstrate initiative and responsibility.
Must have good listening skills, and be able to effectively and clearly communicate (written and verbal) in English both one-on-one, and in a group setting. Bilingual English/Spanish a plus.
Knowledge of medical terminology and regulatory agencies such as federal, state, CMS (formerly known as HCFA), DMHC, and NCQA preferred.
Ability to read and interpret health plan benefit manuals and CPT and ICD information.