Job Description

Remote with onsite/virtual training. Work from home position after training completion

Position Summary:

This position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services. Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.

Essential Functions and Responsibilities:

1. Meet the Department standard of calls answered, and call documentation entered.

2. Assist Members and Providers with questions and concerns.

• Finding Provider(s)/Services for members
• Arrange Transportation for members
• Answer billing/claims status questions; resolve claim issues for members
• Assist with pharmacy issues
• Help Members access community support services
• Verify member eligibility
• Quote benefits
• Assist with Referrals
• Assist with member health assessments
• Assist members with closing gaps in care

3. Ongoing member education.

4. Responsible for all benefits information given to Members and Providers.

5. Participate in Departmental Projects, as appropriate.

6. Coordinate quality improvement initiatives with Medical Management, Provider Relations, and Quality Depts., i.e., Preventative Health Screenings.

7. Other duties as assigned or when necessary to maintain efficient operations of the department and the Company as a whole.

*** This is a 52% markup need. Contractors need to make a facility mandated xx18.00 per hour ***
Requirement description :

• 1 Years of Experience - Required
• Needs to be Spanish speaking - Required - please notate in Profile
• High School Diploma - Required - proof not needed in submission
• 1+ year in a call center - Required
• Bilingual applicants preferred-eligible for xx1 increase in pay rate
  
• This is a 52% markup need. Contractors need to make a facility mandated xx18.00 per hour
  
• Candidates must reside in Indiana- Required

Health system-wide profile standards

• References NOT required.
• A skills checklist completed within one year of application for RN specialties is required. All other professions outside of Nursing are not required but preferred.
• Michigan license verification is required for nurses. Please provide LARA and Nursys; if there is a license hit, it would be in the traveler s best interest to provide a write-up of what happened for the manager's review.
• Physical copies of certifications are only required in the profile if listed above.
• Full-time employees of McLaren are not eligible for contract hire within six months of employment.

ADDITIONAL LICENSE REQUIREMENTS :
Weekend Requirements : None
On Call Requirements : None

Job Tags

Hourly pay, Permanent employment, Full time, Contract work, Temporary work, For contractors, Remote job, Weekend work,

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