Care Manager

Description

Position Summary:

Care Manager responsibilities will vary by program and its lifecycle. Care Manager’s may be responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance and check prior authorization and/or appeal status. Care managers may also be responsible for directly contacting patients and/or providers to evaluate eligibility for assistance programs and/or varied adherence support.

This is a remote position.

The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job.

Primary Responsibilities:

- Responsible for all inbound and outbound phone calls to patients and providers.

1. Responsible for single point of contact communication with providers and patients in a designated geographical area

2. Contact insurance companies to perform appropriate benefit investigation(s) and coverage eligibility for client product only

3. If applicable, assist with the prior authorizations with specific attention to detail and accuracy with provided information.

4. Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs

5. Provide courteous, friendly, professional and efficient service to internal and external customers including physicians and patients.

6. Update job knowledge by participating in educational opportunities and training activities

7. Work efficiently both individually and within a team to accomplish required tasks

8. Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures

9. Eligibility authorization and enrollment into Patient Assistance Program(s)

10. Ability to verify insurance requirements to support current billing processes

11. Demonstrate a firm grasp of medical billing processes communicating knowledge to internal and external customers

12. Identifying and providing corrective action for medical billing reimbursement support specifically to provider offices

Required Qualifications:

1. High School Diploma or equivalent, some college preferred

2. Minimum two years experience in pharmacy, medical billing, insurance verification, and/or similar related healthcare experience; must include work with J-code and/or HCPCS

3. Customer Service experience

4. Healthcare experience

Preferred Qualifications:

1. Previous experience in Patient Support Services (Hub)

2. Previous Customer Service experience in the healthcare field

3. Bilingual

Professional Competencies:

1. Business Skills and Knowledge

• General Management

Demonstrate analytic and problem solving skills, and understand the impact of individual decisions on other parts of the organization and the environment.

• Quality improvement

Application of techniques that continually improve the quality of care provided, patient safety, organizational performance, and the financial health of the organization.

2. Knowledge of the Health Care Environment

• Health Care Systems and Organizations

Demonstrate an understanding of how the various components of the health care system is organized and financed, and how they interact to deliver medical and healthcare.

• The Patient’s Perspective

Understand the patient experience, demonstrate a commitment to patients’ rights and responsibilities, and ensure that the organization provides a safe environment for patients and their families.

3. Communication and Relationship Management

• Relationship Management

The ability to build and maintain relationships with internal as well as external stakeholders that are anchored in trust and where decision-making is shared.

• Communication Skills

Be able to utilize verbal, written and presentation skills to communicate an organization’s mission, vision, values and priorities to diverse audiences.

4. Professionalism

• The ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and community, a service orientation, and a commitment to lifelong learning and improvement.

Skills

insurance verification, prior authorization, medical insurance, Call center

Top Skills Details

insurance verification, prior authorization, medical insurance

Additional Skills & Qualifications

1. High School Diploma or equivalent, some college preferred

2. Minimum 6 months to one year experience in medical billing, insurance verification, or similar related medical office experience

3. Previous data entry experience (minimum three months) and ability to type 30wpm+

4. Able to demonstrate high attention to detail in work

5. Must be computer savvy, to include navigating multiple computer tabs, monitors and applications

6. Advanced ability/knowledge of all Microsoft Suite programs (Teams, Word, Excel, Outlook, etc) and soft phone systems (WebEx, Mitel, Shoretel, etc.)

7. Exceptional communication skills, both written and verbal

8. Able to work in a virtual team environment by being available and responsive during working hours

9. Excellent follow through

10. This is a remote position. Employees must have a private workspace free of distraction to adhere to HIPAA compliance/guidelines. Workspace must include internet plug-in accessibility. Wi-fi connectivity is not permitted.