This is a temporary position, scheduled to go 5 months, could extend.
1. Assist the Health Plan Transportation team with resolving member transportation issues, documenting issues into the Health Plan complaints tracking log located on the HP SharePoint.
2. Responsible for assisting in prior authorization of transportation requests sent by Transportation Vendor, which can include:
Making outreach calls to members and providers, verifying information regarding need for transportation
Geo-Access reviews and processing prior authorizations for transportation requests
Work closely with MD and/or RN for cases that are more complex and require oversight of decisions
Identify members' needs, clarify information and provide solutions and/or alternatives.
Handle customer complaints respectfully and professionally
Conduct thorough research and properly respond to complaints and/or inquiries from members, providers and internal departments regarding member transportation needs related to prior authorization issues
3. Complete research as needed by the Health Plan Operations team analyzing and composing data into a usable format.
4. Claims and Clinical documentation, research, and knowledge.
5. Able to work with a SharePoint, Healthcare Management Authorization systems, Claims processing systems, and other software applications (CSP Facets, Sales Force, NDB)
6. Assigned duties as needed
• Associates Degree
• 2+ years of Customer Service working in Physician’s office, Clinical Setting, or Call
• 2+ years of professional experience in an office setting using the telephone and
computer as the primary Instruments to perform job duties.
• Must be able to create, copy, edit, save and send utilizing Word, Excel, and Outlook
• Must be able to navigate a PC
• Works independently with minimal supervision
• Bachelor Degree
• Healthcare or Insurance Benefits experience
• Professional Experience in a Clerical or Administrative role
• Knowledge or experience with Medical Terminology/Coding
• Medicare or Medicaid Experience
• Experience with Clinical Database