AVID Technical Resources is seeking a Case Management Coordinator to work Remotely for our Health Care cilent in West Los Angeles
- Job Description:Referral process are completed observing Medical Group and Health Plan Policies and Procedures, Posted Medical Group Guidelines, including but not limited to the interpretation and documentation of the Medical Group Referral Matrix, benefits (if applicable), determine financial responsibility in accordance to the medical group.
- Receives and processes complex referral authorization request. Must document research and findings in electronic health record or appropriate system. Runs reports utilizing the electronic medical records or appropriate system to aid in prioritizing, processing or reporting on referrals.
- Researches health plan benefit and eligibility issues for each service and enters documentation of information into the managed care electroninc health record module or appropiate system.
- Responsible for timely processing for all referral requests for services as per health plan requirements. Will notify supervisor in writing when unable to meet this requirement, including scanning and handling of pended referrals requiring additional review by nurse or physician.
- Serves as back up to others on the Case Management Team within the department and is able to perform all functions of the Case Management team.
- Receives telephone calls,e-mails, and all other electronic verbal or writtern coorespondance regarding member referrals or issues. Resolves all inquiries within the same business day.
- May be required to document in the appropiate the managed care electronic health record system. Calls members, providers and vendors to resolve issues or questions related to member referrals.
- Processes daily hospital admissions and reported out-of-area hosptial admissions, Documents the out-of-area admissions into the appropriate system.
- Initiates and maintains medical record files for patients meeting Case Management criteria or will document in the case management module in the electroinic health record or appropriate system.
- Assists Departements in the collection of information needed to respond to Appeals and Grievance cases and health plan audits
- Reviews claims referred by the Claims Department for
- REQUIRED QUALIFICATIONS:High school diploma, GED or equivalent.
- Experience working in a Managed Care environment preferred.
- Experience processing ambulatory Managed Care referrals.
- Vodavi phone system experience preferred.
- Ability to operate a wide variety of office equipment, including computers, printers, copy machines, facsimile receiver/transmitter, scanners and mailing equipment.
- Proficient computer skills including working knowledge of Microsoft Excel and Word.
- Ability to multi-task, work with frequent interruptions and meet deadlines.
- Must be detailed oriented, attentive, organized, and able to follow directions.
- Ability to communicate thoughts and information clearly and succinctly in writing as well as verbally.
- Ability to lift up to 25 pounds.
Estimated Pay Rate Range
Contract Hourly Rate ranging: $21 USD
About AVID Technical Resources:
AVID (Applications, Voice, Internet, Data) Technical Resources is a contract and permanent IT recruiting company. Headquartered in Boston with 9 offices around the US, AVID specializes in placing information technology professionals with either an Infrastructure Support or Applications Development background.
Since our inception in 2003, AVID has grown to be among the leading IT recruiting firms in the area. This explosive growth has led to a number of awards and recognition. Inc. Magazine listed AVID three times on their exclusive Inc. 500/5000 Fastest Growing Privately-Held Companies in the US. AVID was named one of the Leading IT Staffing Agencies in the Northeast by Forbes Magazine and the Boston Business Journal ranked AVID Technical Resources the 7th Fastest Growing Privately-held Company in Massachusetts. AVID Technical Resources has not only been recognized by local and national business and staffing organizations, but also by its most important critics: our clients and candidates. Check out our reviews on Glassdoor, Indeed, and Google here.
Contact one of our IT recruiters today: www.avidtr.com.