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 to inform and educate them on our medical management programs; conducting research, performing data entry, responding to inquires from members, and supporting the clinicians in the Medical Management department with their provider and member activities.- Perform outreach and follow up attempts to members. Inform and educate members on the medical management programs, using supplied scripts. 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.
- 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 customer or provider information.
- Serve as contact for medical necessity review/network steerage for pending transplants. Monitor the case management work queue for pre-transplant out patient cases, initiating new pre-transplant cases. Verify eligibility and network requirements using the medical management system as well as other resource as appropriate. Serve as a liaison between Medical Management and BCBSA and as a resource for providers and/or members.
- Obtain required or missing information via correspondence or telephone.
- Serve as contact for the FSU regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from FSU, reopen 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, 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 related business.
- Maintain effective 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) or medical systems (i.e.; hospital or doctor office).
- Experience coordinating member needs, providing assistance to members, and analyzing member needs.
- Knowledge of medical terminology.
- Knowledge of medical claims systems.
- PC proficiency including Microsoft Office applications.
- Customer service skills.
- Verbal and written communications skills including developing written correspondence to members and to other department personnel and coaching skills to educate members on medical issues.
PREFERRED JOB REQUIREMENTS:
- College courses in computer science or the medical field.
- Health Benefit Experience
- Experience with Referrals
This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.
Compensation: $17.20 - $27.15
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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