Provides office and case management support services. Serves as a contact between members, physicians, providers and CalOptima staff to gather information. Also serves as interpreter when necessary. Position is responsible for providing effective, efficient and courteous interaction with providers, members/family and other CalOptima staff, under the direction of the licensed Medical Case Managers, or Gerontology Resource Coordinator. Performs medical administrative and/or routine tasks specific to the assigned program. May also perform office support functions.
- Receive cases via fax, phone, or electronically and enters the new case information into the Facets and CCMS systems.
- Conduct individual interviews/assessments with CalOptima members and/or providers to obtain intake information.
- Obtain information on requested services according to CalOptima Health Services Department guidelines, performing data entry into Facets and CCMS, and verifying eligibility. Contact the Health Networks and/or CalOptima Customer Service regarding health network enrollments.
- Assist the case managers in gathering medical records, obtaining appropriate information on diagnosis and procedures, and follow up on phone calls as directed by the Medical Case Managers, or Gerontology Resource Coordinator.
- Document all contacts and case information in the appropriate Facets and CCMS modules, using the standard charting format.
- Perform data entry into the appropriate databases for monitoring and tracking, trending of cases and other relevant databases as needed. Generate monthly and other required reports from the databases as requested by the Case Manager and/or health networks.
- Provide customer service to providers and members.
- Other duties as assigned by management.
- Verbally communicate adequately to obtain relevant needed data from members, providers, etc., and record and summarize findings.
- Communicate with individuals from varying cultural and ethnic backgrounds.
- Develop and maintain effective working relationships with all levels of staff, other programs, community agencies, providers and members.
- Effectively utilize computer and appropriate software and interact as needed with CalOptima Information Systems.
- Utilize prior authorization protocols to determine when to refer matters to a licensed staff person.
Experience & Education
- High school graduate or equivalent.
- 2 years of related experience that would provide the knowledge and abilities listed.
- Bilingual skills in either English/Spanish or English/Vietnamese highly desirable.
- Knowledge of:
- Microsoft Office Programs: Outlook, Excel, and Word required.
- Medical Terminology.
- Medi-Cal benefits and regulations.
CalOptima is an integrated health care system that administers health insurance programs for Orange County children, low income families,...