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- Jacksonville, FL
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Health Care Finder
Beacon Health Options • Jacksonville, FL
Posted 20 days ago
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ABOUT THE POSITION
We are currently seeking a dynamic Health Care Finder to join our team at our office in Jacksonville, FL. Under the direction of the Customer Service Supervisors, the Health Care Finder (HCF) is responsible for resolving and responding to telephone inquiries from beneficiaries and providers. Responsibilities include providing accurate and thorough interpretation of benefits, eligibility, behavioral health referrals, building non-medical necessity review authorizations for claims payment purposes and assisting callers in accordance with the Federal TRICARE South Contract.
•Answer incoming telephone calls from customers and provide information on benefits and eligibility in a clear and professional manner.
•Provide customers with names of providers in their geographical area and verify network status of providers in accordance with contract standards.
•Gather specific information from the caller in order to determine which department and/or personnel can best respond to the customer’s concerns.
•Create complete call record for each contact made with a customer in the INFOrm system. The HCF may need to create more than one call record per customer call.
•Checks and verifies TRICARE eligibility of beneficiaries through appropriate systems. Collects and transfers non-clinical data such as beneficiary demographic information and eligibility determination, and requested assistance, to the appropriate department based on incoming telephone calls.
•Build cases in MSR system and authorize the TRICARE initial visits each fiscal year or the second provider outpatient visits for claims payment purposes. No medical necessity determination required.
•Will adhere to pre-approved procedures and standards of practice (SOPs) for non-clinical functions. Will not conduct any activities that require interpretation of clinical information. Will seek the direction and receive guidance and oversight from clinical staff, Clinical Supervisors or Director of Clinical Services as appropriate.
•Transfer calls ensuring accurate information is relayed to the other party so appropriate service can be provided.
•Monitor the volume of calls in the queue line to ensure contract compliance is met.
•Achieve and maintain high-level productivity and quality performance expectations.
•Ensure the appropriate use of the chain of command.
•Effectively navigate through multiple complex systems/screens.
•Verify demographic information with beneficiaries/providers and ensure Health Insurance Portability and Accountability Act (HIPAA) guidelines are followed to protect privacy.
•Provide basic claims research, within TRICARE navigation (TNAV), in order to assist a customer with the status of their claim.
•Provide follow-up with other internal departments to expedite resolution of difficult/aging inquiries.
•Perform job functions in accordance with the latest Customer Service Department’s Standard Operating Procedures (SOP) and the latest TRICARE Policies and Procedures (P&P).
•Complete employee responsibilities, as required. This includes reading and responding to business email communication, completing required trainings in the timeframe specified and completing kitchen duty, when assigned.
•Comply with all HIPAA regulations.
•Maintain punctuality and regular attendance. Giving proper notification when unable to meet this requirement.
•Maintain a professional relationship with co-workers.
Perform special projects and duties, as assigned.
Education: High School Diploma, Associates Degree or equivalent related experience.
Relevant Work Experience: Requires a minimum of two years of Customer Service experience. Prefer previous experience in an ACD call center environment within the healthcare industry. Knowledge about the military is helpful.
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled