Case Specialist
Job ID 2013-25244 # Positions 1
Location US-MD-Hanover
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 12/6/2013
Additional Locations ..
More information about this job:
Summary:
Provide manage care and services to members. Coordinate services/health care services by facilitating, scheduling, and arranging a variety of treatment and services. Complete authorizations, correspondence, and manages phone queues within the department.
Effective December 16, 2013, this job will have a WellPoint title of Medical Mgmt Specialist I
Responsibilities:
1. Coordination, authorization, fulfillment, reporting, monitoring and tracking of services.
2. Responsible for responding to inquiries from Members and Providers to clarify benefits, provide member education and member referrals.
3. Establish working relationships with referral sources, providers, community agencies and vendors to proactively coordinate access to services.
4. Maintains and supports documentation, logs and data entry to monitor activity and/or outcomes related to care coordination services in an accurate and timely manner.
5. Documents all pre-certification and authorization requests as well as member encounters utilizing the appropriate systems and resources.
6. Initiates contact with assigned individuals/personal representatives, guardians and providers to determine member’s response to services.
7. Completes initial screening and makes outreach calls to members. Performs assessments under the supervision of a nurse/clinician, as appropriate.
8. Refers members to case management or other clinical programs as indicated.
9. Collaboratively works with other departments to meet member needs and support departmental business initiatives.
10. Completes department letters or other correspondence, as assigned.
11. Ensure compliance with all department timelines including telephone service standards and turn-around times.
12. Manages pended claim, authorization, or error reports as assigned.
13. Perform other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Associate Degree or equivalent work experience.
Preferred:
- Bachelors degree.
Years and Type of Experience Required:
Required:
- Minimum of 2 years working in a Health Services field.
Preferred:
- MCO/ Health Insurance Experience.
- Medicaid/Medicare.
Language Skills
Required:
- English
Preferred:
- Bi-lingual
Functional Competencies
- Ability to use Microsoft Office (e.g. Outlook, PowerPoint, excel etc.) to complete certain simple tasks and use of basic office equipments.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites.
- Knowledge of Medical Terminology preferred.
- Good communication skills, both written and verbal; ability to respond to customers from internal/external in an understandable and unambiguous manner.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
Options:
- Apply for this job online
- Email this job to a friend
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Job ID 2013-25244 # Positions 1
Location US-MD-Hanover
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 12/6/2013
Additional Locations ..
More information about this job:
Summary:
Provide manage care and services to members. Coordinate services/health care services by facilitating, scheduling, and arranging a variety of treatment and services. Complete authorizations, correspondence, and manages phone queues within the department.
Effective December 16, 2013, this job will have a WellPoint title of Medical Mgmt Specialist I
Responsibilities:
1. Coordination, authorization, fulfillment, reporting, monitoring and tracking of services.
2. Responsible for responding to inquiries from Members and Providers to clarify benefits, provide member education and member referrals.
3. Establish working relationships with referral sources, providers, community agencies and vendors to proactively coordinate access to services.
4. Maintains and supports documentation, logs and data entry to monitor activity and/or outcomes related to care coordination services in an accurate and timely manner.
5. Documents all pre-certification and authorization requests as well as member encounters utilizing the appropriate systems and resources.
6. Initiates contact with assigned individuals/personal representatives, guardians and providers to determine member’s response to services.
7. Completes initial screening and makes outreach calls to members. Performs assessments under the supervision of a nurse/clinician, as appropriate.
8. Refers members to case management or other clinical programs as indicated.
9. Collaboratively works with other departments to meet member needs and support departmental business initiatives.
10. Completes department letters or other correspondence, as assigned.
11. Ensure compliance with all department timelines including telephone service standards and turn-around times.
12. Manages pended claim, authorization, or error reports as assigned.
13. Perform other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Associate Degree or equivalent work experience.
Preferred:
- Bachelors degree.
Years and Type of Experience Required:
Required:
- Minimum of 2 years working in a Health Services field.
Preferred:
- MCO/ Health Insurance Experience.
- Medicaid/Medicare.
Language Skills
Required:
- English
Preferred:
- Bi-lingual
Functional Competencies
- Ability to use Microsoft Office (e.g. Outlook, PowerPoint, excel etc.) to complete certain simple tasks and use of basic office equipments.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites.
- Knowledge of Medical Terminology preferred.
- Good communication skills, both written and verbal; ability to respond to customers from internal/external in an understandable and unambiguous manner.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
Options:
- Apply for this job online
- Email this job to a friend
Go back to the welcome page
Need further assistance·
Powered by the iCIMS Talent Platform (Opens new window)
Applicant Tracking Software
ermHO