Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This Position Is Responsible For Contacting Members, Clinical Staff, Community Partners And Physicians On Case And/Or Care Management. Contact Members To Inform And Educate Them On Our Medical Management Programs. Conducting Research, Performing Data Entry, Responding To Inquiries From Members, Assist With The Completion Of Health Risk Assessments, And Receive Member Calls Regarding Quality Of Care And Supporting The Clinicians In The Government Programs Department With Their Provider And Member Activities.- Perform outreach and follow up attempts to members. Inform and educate members on the Government Programs. Complete records in system by performing data entry. Encourage member usage of our programs. May include scheduling appointments. Generate appropriate correspondence and send to member manually or electronically.
- Maintain production requirements based on established department business needs. Document case information in a timely manner
- Provide support to the clinical team by performing the non-clinical functions (as identified by the business process) necessary to generate and close a case within the platform.
- Receive, analyze, conduct research and respond to telephone and/or written inquiries. Process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Respond to customer or send to appropriate internal party.
- Notify help desk of system issues.
- Perform data entry function to update member, community partner or provider information.
- Serve as contact for medical necessity review. Verify eligibility and network requirements using the medical management system as well as other resource as appropriate.
- Obtain required or missing information via correspondence or telephone
- Responsible for responding to telephone and/or written inquiries, working independently and consistently meeting the needs of members, community partners, co-workers, management, etc. Receive, research and process information from member or provider to determine needs/wants and ensure customer questions have been addressed.
- Serve as contact for the FSU regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from the FSU, re-open or initiate new cases as needed and refer case to clinicians.
- Support and maintain communications with various in-house areas regarding groups' concerns, i.e.: Marketing, Provider Affairs, etc. and SSD.
- Communicate and interact effectively and professionally with co-workers, management, customers, etc.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
- 1 year of college and 2 years experience with automated systems OR 3 years experience with automated systems.
- 1 year experience with managed care system(s).
- Experience coordinating member needs, providing assistance to members, and analyzing member needs.
- Knowledge of medical terminology.
- Knowledge of managed care claims systems.
- PC proficiency including Microsoft Office applications.
- Customer service skills.
- Verbal and written communication skills including interpersonal skills to assist and educate members and coordinate care with community partners, physician offices, developing written correspondence to members and to other department personnel, and to support department personnel and functions.
PREFERRED JOB REQUIREMENTS:
- Healthcare Insurance knowledge with Medicaid or Managed Care
- Previous experience with the Medicaid and Medicare population
- Excel and Microsoft experience
This is a Telecommute (Remote) role: Must reside within 60 miles of the office or anywhere within the posted state.
Compensation: $17.20 - $28.81
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click here
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