Summary Description:
This position has responsibility for supporting the workflow of the Medical Services in all regions. Depending on the specific tasks assigned, the Medical Services Specialist provides administrative support for any of the programs of utilization management or case management. The Medical Services Specialist acts as a resource for staff regarding members specific contract benefits, consistent with products, policies and procedures and related health plan functions such as member services, claims, and the referral process.
Essential Resource Responsibilities / Accountabilities:
- Maintains thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures in order to identify eligibility and coverage and assisting other staff with related inquiries
- Maintains privacy and confidentiality of member information in accordance with Corporate Policy
- Performs unit specific workflow processes consistent with corporate medical & administrative policies, employer specific guidelines, and/or regulatory agencies
- Produces, records, or distributes information for others
- On a periodic basis, tracks and reports department performance against benchmarks
- Serves as the primary contact for provider contacts, including authorization and information requests, claim inquiries, and other related inquiries
- Provides friendly, accurate, and timely assistance
- Prepares and assists in handling correspondence
- Assures accuracy and timeliness of processing
- Provides timely response to all research inquiries from other departments and assures the response is thorough and accurate
- Monitors and coordinates unit specific workflow to ensure accurate and timely turnaround of all incoming requests for services and that review timeframes are maintained
Minimum Resource Qualifications:
- LPN, Medical Assistant, Health Care or Health Plan customer operations experience
- A minimum of one year experience working in an insurance company or medical care setting required
- Working knowledge of the claims systems preferred
- Must demonstrate proficient experience in the use of a computer
- Examples-creating documents, Excel, Internet and/or email
- Excellent oral and written communication skills
- Ability to develop in depth knowledge of complex rules, such as those of the authorization process, including departmental policies and procedures, product lines, and contract benefits
- Demonstrates organizational and interpersonal skills; able to manage multiple tasks under pressure
- Must have the ability to travel.
Physical Requirements:
- Active: 25% Sedentary: 75% In support of the Americans with Disabilities Act, this resource requirements document lists only those responsibilities and qualifications deemed essential to the position
Equal Opportunity Employer:
Excellus Client Client is an Equal Opportunity Employer. As such, requires all suppliers of temporary staffing resources to affirm the rights of every person to participate in all aspects of employment without regard to race, color, sex/gender, age, disability, religion, creed, citizenship status, national origin, veteran status, military status, marital status, familial status, domestic violence victim status, sexual orientation, gender identity, predisposing genetic characteristic, genetic information, or any other status protected under the law
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.