CSCC - Virtual Coordinator
Job Closed
Overview
Required Skills and Experience: •2+ years’ experience in a customer service, health care organization, Community Based Organization, or social services environment. • Valid New York State driver’s license •Demonstrated experience in a managed care or HMO setting is strongly preferred, because in depth knowledge of managed care product portfolio, benefits, policies and procedures is a must. •Three (3) to Five (5) years of progressively responsible in a high-volume call health care or social service related. •Understanding of the needs and dynamics of elder care services, disadvantaged, disengaged populations. •Experience in participating in cross departmental projects and policy and procedure changes, including coordination of activities and initiatives across departments. What you need to know: 1. Must be able to travel to other office locations as necessary 2. Looking for folks who have a flexible work schedule with a passion for customer service and process improvement 3. This position has a broad range of on and off call responsibilities. On call responsibilities include responding to customer inquiries in areas of enrollment, billing, claims, benefit interpretation, and referrals/authorizations for medical care. Other on call duties include Help Desk support and the handling of escalated issues (calls). Off call work may include service issue research and resolution, reporting, special projects, assist with training, facilitating, and attending meetings, walk-in coordinator duties on a back-up basis as needed, etc. Additional Job Details: •Provide on-going support to members related to the coordination of and access to services, grievances, and appeals, claims inquiry, social services etc. •Meet with physician representatives to identify member health needs as necessary. •Work with internal Belong Health DSNP staff to resolve member issues around billing, service denials, payment, authorization, interaction, appeals, grievances and other member issues. •Ensure complete communication feedback to/from members regarding problem resolution, product design, and member eligibility, other post-enrollment activities, etc. •Ensure compliance with CQL measures and standards. •Familiarize member with appropriate member communication materials, including evidence of coverage, network directories and other materials as necessary. •Ensure accurate and updated member information and communication on Belong Health website. •Facilitating and monitoring the implementation of the member care plan in accordance with recommendations by the Interdisciplinary Care Team and ensuring accurate and timely authorization.
Company
Our client is a Hospital and Health Care company that partners with regional health plans and hospital systems to help deliver a more compassionate, straightforward insurance experience for Medicare-eligible individuals. They help deliver best-in-class Medicare Advantage (MA) and Specials Needs Plan (SNP) products, creating new opportunities for organic growth that enable better service for their existing membership.