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Specialist - Benefit + Issue Resolution

Specialist - Benefit + Issue Resolution

Job ID 
2017-4252
Job Locations 
US-Remote
Category 
..

More information about this job

Overview

This position maintains and enhances Health plan (s) satisfaction through supporting the facilitation of issues resolution essential in maintaining a collaborative relationship. Supports and serves the Care and Service Centers, assigned Health plan (s), referral sources and CareCentrix providers as a resource regarding CareCentrix home care services. Works under moderate direction from the   Benefit and Issue Resolution Supervisor or Manager.

Responsibilities

  • Organizes and assigns workload to team members per pre-arranged protocols. Tracks assignments and reports status to Mgt team to ensure resolution turn- around times are met
  • Supports the Benefit and Issue Resolution Mgt Team to provide reports regarding issue tracking, trending and root cause and other items as needed.
  • Serves as a resource to help facilitate timely and appropriate use of home care, home infusion therapy and home medical equipm
  • Works with Health Plan(s) staff in the coordination of complex home healthcare need
  • Collaborates with Health Plan(s) staff to insure appropriate compliance with Health Plan (s) guidelines and pre-certification require
  • Acts as support between CareCentrix Care and Service Centers and other internal departments to gain resolution regarding issues or concerns. Seeks clinical advice and guidance from clinical staff when required
  • Assists in the coordination of resolutions regarding quality of services issues with Quality Improvement, embracing and practicing the principles of quality to insure and help restore excellent care and service.
  • Assists Revenue Cycle Management (RCM) on billing and claims issues as needed.
  • Provides on-sight support to assigned Health Plan (s) offices as required.
  • Participates in special projects and performs other duties as assigned.

Qualifications

Associate’s Degree in Health Care Field or two years equivalent experience in managed care, home care or related industry required. Excellent verbal and written communication and ability to prioritize daily. work load. Knowledge of medical terminology, abbreviations, disease, illness, and injury processes. Proficiency in Outlook, Word and Excel with ability to create various reports. Familiarity with a variety of internal and external software programs.

 

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.