This position receives/ to incoming calls from referral sources/potential patients for CareCentrix and in New York, for CareCentrix IPA, a wholly-owned subsidiary of CareCentrix. Involved in the collection, verification and confirmation of clinical and demographic information. Gathers information using scripted clinical and non-clinical questions. Is able to provide appropriate issue resolution and/or escalation when needed. Performs utilization management and participates in performance improvement activities (specific measurement for contracts). Works under moderate supervision, with clinical oversight and input.
Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
Receives/responds to incoming calls from referral sources/potential patients, exchanges information to identify the patient’s needs and determines the Company's ability to meet them. Records the outcome of calls in the proper screen.
Performs initial telephone screening to review the request for service for completeness.
Involved in the collection, verification and confirmation of non-clinical information. Gathers structured clinical documentation. Is able to provide appropriate non-clinical issue resolution and escalation of issues when needed.
Consult Applicable Payer Fact Sheets in Registration Process. Works with the Intake team, other staff and patients to identify potential solutions as problems are identified with payer sources.
Communicates customer service issues to supervisor when necessary.
Participates in and contributes to utilization management and performance improvement activities. Is committed to quality and company standards.
Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. Complies with Utilization Management and URAC standards.
Participates in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
Reviews and adheres to all Company policies and procedures and the Employee Handbook. Participates in special projects and performs other duties as assigned.
This position requires excellent communication, customer service and problem solving skills, as well as, the ability to effectively interact with all levels of management and a highly diverse clientele. Must have strong organizational skills and be able to effectively manage and prioritize tasks. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
High School Diploma or the equivalent plus a minimum of one year medical terminology or medical services experience required. Knowledge of basic spreadsheet / word processing / data entry preferred. Experience in a call center environment preferred. Knowledge of Utilization Management and URAC standards.
CareCentrix - 22 months ago