Health Services Coordinator (52451)
WHO WE ARE:
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
WHO YOU ARE:
This position, under the direction of the Supervisor, Heath Services Coordination, provides administrative support for utilization review, health education and care management. This includes data entry, communication with members, providers, and vendors for education and information gathering.
ESSENTIAL JOB FUNCTIONS:
- Following Medicare/Medicaid Timelines for Notification to Provider/Members to meet department goals and requirements.
- Verbal and/or written outreach to members and/or providers to provide updates on referral request status, reasoning behind decisions, and provide accurate information.
- Daily Mail fulfillment – faxes to provide notification to provider or member of decisions,
- Coordination of services for members, including community resources and collaboration with assigned case manager
- Develop and maintain resources related to the department.
- Support departmental initiatives.
- Identify and report process improvement opportunities.
- Manage and document member and provider calls.
- Enter authorization requests in the medical management systems.
- Process member notifications
- Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
- Performs other duties as assigned.