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The Sr. Business Analyst will support the Revenue Cycle Management (RCM) department with new client and vendor implementations, and identifying opportunities for system and or process improvements. Participates in documentation of detailed business and system requirements, data analysis and User Acceptance Testing. Participates in the development of test scripts, executes test plans and defect resolution. Serves as a liaison between business owners, end users, and IT partners ensuring cohesive approach, comprehensive solutioning, and excellence in delivery. Responds to ad hoc requests for support and analysis.
This position supervises a team of non-exempt associates within assigned unit in Operations. Monitors performance and productivity of individuals and the team and takes appropriate action to ensure department goals are met including, but not limited to regular scheduled and just-in-time coaching, recommending re-training, performance management and mentoring associates. Manages payer, provider and patient complaint resolution. Consistently identifies areas of opportunity/process improvement within department and recommends solutions as necessary.
The Project Liaison collects, creates, maintains, and supports all departmental project and administrative needs for the Provider Network Management team. This role requires great attention to detail and the ability to assist the Shared Services team to keep projects moving forward and drive outcomes.
Network Contract Managers drive all aspects of provider network management for an assigned geographic area, typically comprised of various states. Not the typical Network Management role, the Managers function like P&L leaders as they have direct responsibility over gross margin which impacts CCX’s profitability (and resulting EBITDA). Serving as the face of CCX to our providers, Managers negotiate contracts (rates & terms), drive in-network utilization by ensuring adequate provider depth (coverage area) and breadth (line of business), and ensure high levels of provider satisfaction by treating CCX network providers (our key asset) as a client.
As a Care Coordinator you will be responsible for tracking and monitoring turnaround times to meet service requirements. You will participate in the collection and documentation of all required data to manage an episode of care from end to end. You will enter data to the appropriate clinical database, generate reports and do analysis to maintain the clinical program's goals.
Customer Service Expert II is proficient and fully functional in two or more of the areas below. Duties are to identify the need(s) of the referring source and/or patient by collecting all necessary data relevant to that need; interpret, verify and process that data to determine if patient is eligible; and facilitate the initiation and termination of the care and services provided in a timely manner. Respond to customer issues that may arise during and after order processing. Actively engages and coordinates with other team members to maintain a positive, collaborative relationship.
- Works closely with health plans/payers and maintains strong business relationships.
- Provides appropriate issue resolution and/or escalation when needed. Works under moderate supervision, with clinical oversight.
- Reviews and adheres to all Company policies and procedures and the Employee Handbook.
- Participates in special projects and performs other duties as assigned.
- Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
- Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
- Participates in and contributes to performance improvement activities.
- Learn, understand and maintain working knowledge of products and services offered by the company.
- Responsible for timely and thoughtful communication to the referral source, physician, and patient to ensure coordination of services and equipment to meet physician prescribed starts of care and/or discharge dates.
- Also responsible for communication to department leadership when difficulty securing a provider jeopardizes safe and timely care for a patient. Requests clinical input, and/or communicates with Client Services when quality of care issues are in question.
- Solicits providers in accordance with CareCentrix credentialing, quality, and pricing guidelines. When working outside of the CareCentrix network adheres to out-of-network qualification standards and ensures pricing is commensurate to CareCentrix client reimbursement.
- Consults with associates within internal CSC functions, as well as CareCentrix manuals and reference pages, to ensure issuance of service authorization forms (SAF) to providers in accordance with payer guidelines.
- Ability to take full accountability and ownership of a large case load from assignment of case ensuring patient discharges timely, or if already home that care begins per the physician’s request. Requires dynamic ability to prioritize multiple times throughout the day, as well as excellence in time management.
- Demonstrate critical thinking skills and utilize appropriate documentation to ensure URAC core and HUM standards are met.
- Receives and responds to incoming calls or faxes from providers, referral sources, and potential patients. Accurately enters information to begin the referral process into the CareCentrix portal and accurately records the outcome of calls in the proper screen.
- Collects and enters clinical and demographic information to begin the referral process along with verifying eligibility and benefits information by contacting health plans or payors to ensure services provided will be covered by the carrier. (e.g., deductible amounts, co-payments, effective date, pre-existing clauses, levels of care, authorization, visit limitations, documentation required to process claims, etc.). Accurately documents all communications and decisions into a computer database.
- Consults applicable Payer Fact Sheets in Intake Process. Works with other staff and patients to identify potential solutions as problems are identified with payer sources.
- Identifies potential payer sources, obtains authorization from the authorizing entity. Accurately documents conversations and decisions with payer sources
- Processes SV Alerts and communicates resolution to the quality team and the patient.
- Responsible for logging all interactions and thoroughly following up with members and providers.
- Files CARTs, completes the Internal Issue Log, and SOC templates when applicable.
- Accurate and complete data collection from referrals and completion of applicable paperwork. Interpret, verify and accurately enter data into computer to process orders.
- Answers telephone calls in a professional, friendly, helpful manner.
- Ensure patient qualifies for the type and quantity of product(s) ordered, based upon the patient’s insurance and/or SMS contract guidelines.
- Obtain insurance authorization, when necessary.
- Promptly respond to and resolve customer issues.
As a Trainer, you will facilitate new hire, customer service, systems, business processes, and new initiative training for an operational business unit. You will will work closely with the business to ensure that associates receive effective on-the-job training support. Position requires facilitation skills and the ability to provide coaching and feedback.
If you have customer service experience and enjoy working in a fast-paced environment, this is a great opportunity for you. CareCentrix is committed to making the home the center of patient care.