Provide customer service for patients, providers and facility staff. Respond to inquiries regarding pended charts, readmit data, admit and discharge dates, bed day and level of care for accurate authorizations. Independently research data for accuracy. Fax clinical correspondence as requested by Healthplan.
Provide coverage for the HBAT telephone line. Triage all calls and transfer accordingly. Send page to Hospitalist when indicated. Monitor right fax folder and convert, save, store and forward per determined work flow in a timely manner. Notify appropriate department or staff when time sensitive documents and orders are received.
Verify insurance coverage, benefit, eligibility and enrollment per determined workflow. Submit Help Desk tickets when indicated and track to completion. Report duplicate charts and update patient demographic information whenever indicated and verified.
Provide cross coverage for co-workers when needed, regardless of assignment. Support Care Transitions Coordinators within the scope of practice and licensure.
Make follow up calls to Facilities, DME, Home Health agencies or Gerinet providers as requested by Care Management Team.
Ensure the authorization process adheres to stated turn around times, are complete, faxed and received by all necessary parties. Ensure the appropriate and pertinent medical information accompanies the referral whenever indicated.
Assist Medical Management team with referral audits as requested by leadership. Review workflow and update policies and procedures when business needs change.
Attend seminars, training sessions, team huddles, case conference, Gallup committee and department meetings as requested by leadership. Perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
Minimum of one year experience with HMO’s/Managed Care.
Knowledge of Utilization operations and prior medical office experience.
Must excel in interpersonal communication and customer service and be able to work both independently and as part of a team.
Must excel in organization and attention to details and follow through. Additionally, they must have the ability to problem solve to logical conclusion and demonstrate initiative and responsibility.
Must have good listening skills, and be able to effectively and clearly communicate (written and verbal) in English both one-on-one, and in a group setting. Bilingual English/Spanish a plus.
Knowledge of medical terminology and regulatory agencies.
Ability to read and interpret health plan benefit manuals and CPT and ICD information.
High school graduate or equivalent.
Internal Number: MEM003358
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.