Two Chicks With A Side Hustle

Primary Responsibilities:

  • Resolve concerns for members, providers, and APCs, triaging to the appropriate discipline when necessary (Dietitian, Nurse Care Manager, Pharmacist, Social Worker)
  • Enhance the experience of both internal and external customers by providing excellent customer service
  • Serve as a bridge between healthcare providers and members to answer questions/address concerns related to member care
  • Retrieve and respond to voicemail messages, triaging as need
  • Call members and/or providers with laboratory and/or test results as needed
  • Access health plan portals to verify benefit eligibility/benefits for patients and seek additional information as necessary
  • Obtains medical records when requested by a provider
  • Perform data entry and complete documentation of calls
  • Perform data entry into the EMR utilizing information from an electronic or hardcopy source (referred to as the ISNP Backfilling process)
  • Input/update patient PCP/demographic into EMR and computer database systems
  • Enter internal referrals to Social Work and Case Managers and locate community resources for members as directed by providers
  • Uploads Informed Consent, ROI, POA, and other documents as necessary into EMR
  • Enter/process/track patient referral data (e.g., medical services, radiology, durable medical equipment, lab orders, specialist referrals) and follow up until completion
  • Generate reports on patient data through relevant computer systems/applications
  • Review/analyze patient data reports (e.g., discharges, hospital admissions/readmissions, skilled nursing facilities) and follow up as necessary
  • Manage internal health plan mailboxes/task boxes in the EMR
  • Ensures PCP communication via auto fax or manual fax of visit notes
  • Demonstrate understanding of Federal privacy regulations (e.g., HIPPA) and safety guidelines/practices (e.g., OSHA)
  • Ensure that all phone interactions meet quality standards set by the department
  • Participate in and contribute to staff meetings and other staff development opportunities and interdepartmental work groups
  • Provide cross-coverage support across the team support and assist with special projects, as needed
  • Work with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
  • Assume other duties as assigned by Supervisor or Manager

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High school diploma or GED
  • Current and unrestricted compact LPN licensure

Preferred Qualifications:

  • Bachelor’s degree preferred in nursing, health education, nutrition, exercise physiology, or closely related field)
  • Experience in call center customer service
  • Intermediate level of proficiency in PC-based word processing and database documentation (Microsoft Word, Excel, Outlook)
  • Bilingual

Soft Skills:

  • Strong organizational skills
  • Strong verbal and written communication
  • Ability to apply critical thinking skills to prioritize and perform responsibilities to meet deadlines
  • Strong interpersonal skills
  • Ability to work well with a team and maintain a positive attitude.
  • Adaptable to rapidly changing priorities
  • Ability to be flexible, open to new ideas
  • Demonstrate a willingness to take on new responsibilities
  • Ability to type 30-40 words per minute