Medical Services Specialist

Consent to Communication and Use of AI Technology: By submitting your application for this position and providing your email address(es) and/or phone number(s), you consent to receive text (SMS), email, and/or voice communication whether automated (including auto telephone dialing systems or automatic text messaging systems), pre-recorded, AI-assisted, or individually initiated from Aditi Consulting, our agents, representatives, or affiliates at the phone number and/or email address you have provided. You represent and warrant that the email address(es) and/or telephone number(s) you provided to us belong to you and that you are permitted to receive calls, text (SMS) messages, and/or emails at these contacts.

Payrate: $17.00 - $18.40/hr
 
Summary:
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.
 
Responsibilities:

• 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 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

 
Pay Transparency: The typical base pay for this role across the U.S. is: $17.00 - $18.40/hr. Non-exempt positions are eligible for overtime at a rate of 1.5 times the base hourly rate for all hours worked in excess of 40 in a work week, or as required by state or local law. Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education and experience. Full-time employees are eligible to select from different benefits packages. Packages may include medical, dental, and vision benefits, health savings accounts with qualified medical plan enrollment, 10 paid days off, 3 days paid bereavement leave, 401(k) plan participation with employer match, life and disability insurance, commuter benefits, dependent care flexible spending account, accident insurance, critical illness insurance, hospital indemnity insurance, accommodations and reimbursement for work travel, and discretionary performance or recognition bonus. Sick leave and mobile phone reimbursement provided based on state or local law. 

Consent to Communication and Use of AI Technology: By submitting your application for this position and providing your email address(es) and/or phone number(s), you consent to receive text (SMS), email, and/or voice communication whether automated (including auto telephone dialing systems or automatic text messaging systems), pre-recorded, AI-assisted, or individually initiated from Aditi Consulting, our agents, representatives, or affiliates at the phone number and/or email address you have provided. These communications may include information about potential opportunities and information. Message and data rates may apply. Message frequency may vary.
You represent and warrant that the email address(es) and/or telephone number(s) you provided to us belong to you and that you are permitted to receive calls, text (SMS) messages, and/or emails at these contacts. You also acknowledge and agree to Aditi Consulting LLC’s use of AI technology during the sourcing process, including calls from an AI Voice Recruiter. AI is used solely to gather data and does not replace human-based decision-making in employment decisions. Calls may be recorded.

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