Description:Position Purpose:Supports administrative care management activities including performing outreach answering inbound calls and scheduling services. Serves as a point of contact to members providers and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.Education/Experience:Requires a High School diploma or GEDRequires 1 - 2 years of related experience
Provides outreach to members via phone to support with care plan next steps community or health plan resources questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service.
Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service
May apply working knowledge of assigned health plans activities and resources.
Serves as the front-line support on various member and/or provider inquiries requests or concerns which may include explaining care plan procedures and protocols.
Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Supports the authorization review process by researching and documenting necessary medical information such as history diagnosis and prognosis based on the referral to the clinical reviewer for determination
Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
Performs data entry to maintain and update various authorization requests into utilization management system
Supports member onboarding and day-to-day administrative duties including sending out welcome letters related correspondence and program educational materials to assist in the facilitation of a successful member/provider relationship.
Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed.
Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health SDOH needs
Performs other duties as assigned
Complies with all policies and standards
Preferred Skills/ Experience:
Knowledge of customer service
Medical terminology
Operation of office equipment.
Bilingual Spanish MUST
Experience Level:Entry LevelAbout TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
