Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
High school diploma or equivalent; 3-5 years managed care or physician’s office experience. Thorough knowledge of customer service, utilization review in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.
• Enter information into electronic record system and state database. High touch telephonic member contact. Assist members searching for providers. Assist providers with member data. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to the department and responsibility. Attend ongoing training and in-services as directed. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
• Screen for eligibility and benefits. Answers phone queues and faxes within established standards. Screen members by priority for CM assessment.
• Coordinates services with community based organizations. Attends marketing and outreach meetings as directed to represent the plan. Produces and mails routine Right Choice Program letters and program educational material for the medical services utilization monitoring program. Helps develop marketing and outreach meetings as directed to represent the health plan.
• Train new Program Coordinators on system and usage. Guide staff regarding benefits, authorization requirements and policy and procedure.
• Data enters assessments and authorizations into the system. Maintains database as directed.
Licenses/Certifications: Pharmacy Technician certificate highly preferred.
Centene Corporation - 14 months ago
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...