Jobs

Care Coordinator | Posted 8-30-2021

About the Role:

We are looking for a talented and motivated Care Coordinator to join our team! The Care Coordinator will provide comprehensive service and support to providers and members as needed. The primary responsibilities include but are not limited to: responding to all provider inquiries regarding authorizations, documenting contacts in the clinical tracking system, managing and maintaining inbound queues for the UM work system, processing complaints, conducting outreach efforts to providers and ensuring all activities deliver a seamless and streamlined experience for both UM staff and providers. This position requires that one be organized, ability to multitask, set priorities and manage time effectively.

Essential Duties and Responsibilities:

●     Follow established health services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent manner.

●     Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction.

●     Develop effective and professional working relationships with internal and external stakeholders and partners.

●     Communicate effectively with members and providers orally and in writing.

●     Assist in gathering and processing data for internal required reports and analysis.

●     Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.

●     Follow UM policies and processes to the management of incoming authorization requests received through fax, mail or telephone.

●     Identify authorization requests for line-of-business, urgency level, type of service, and assess for complete/incomplete record submission.

●     Perform complete, accurate, and consistent data entry into system software applications in accordance with policies, procedures and instruction from UM management.

●     Answer inbound UM phone queue calls timely to assist members and/or providers regarding inquiries involving authorizations, services, and/or benefits.

●     Process written and verbal notifications of authorization determinations to members and/or providers within regulatory processing timeframes.

●     Complete other duties and special projects as assigned.

 

 

Core Qualifications:

●     Minimum two years of experience in a health care setting in positions requiring interaction with members and/or providers.

●     Working knowledge of managed care, ancillary and hospital-based services, DME and home health services.

●     Passion for top-notch customer service.

●     Knowledge of medical terminology including RVS, CPT,ICD-9, ICD-10, and CPT 4 codes.

●     Completion of a recognized Medical Assistant degree or certificate is a plus.

●     Demonstrated ability to work collaboratively, multi-task and meet deadlines in a complex, rapidly evolving environment with staff across the organization/departments.

●     Proficiency in MS Office suite.

●     Strong attention to detail and critical thinking, problem solving and analytical skills.

●     Strong interpersonal, communication, organizational and time/project management skills are essential.

●     Excellent written and verbal communication skills.

For more information about Trivium, visit www.trivium.com Interested applicants may forward a résumé, cover letter and references to the attention of Ramya at ramya.ramesh@triviumcs.com.

We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: poster_screen_reader_optimized.pdf

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