[Hiring] Medical Case Manager Assistant / WC Scheduler @Tristar Insurance

Role Description

This is a remote position. Preference is remote in Texas.

Work directly with the Supervisor and Manager to provide additional resources to the case management staff. This position does not provide any clinical review or decisions.

This individual is responsible for ensuring the referrals are set up in the Utilization Review/Case Management system and promptly assigned to the case manager. The Case Management Assistant will:

• Answer incoming calls, screen, respond, and route the calls.
• Work independently to meet deadlines.
• Exhibit an excellent phone demeanor and a desire to provide exceptional customer service.
• Possess knowledge of medical terminology and understanding of referral criteria by client and/or jurisdictions.

Qualifications

• Education: High school diploma required. Medical or Managed Care background preferred and/or Certified Medical Assistant.
• Experience: Minimum of one year of working in a medical or managed care environment preferred. Medical Terminology preferred.
• Knowledge, Skills and Abilities:
  • Experience in healthcare related fields.
  • Strong communication skills; customer service mindset; team player.
  • Adheres to professional standards, codes of ethics, system and department policies and procedures.
  • Incorporates the philosophies of continuous quality improvement, customer service, and teamwork into daily routine.
  • Excellent typing and keyboard skills (35-40wpm).
  • Ability to work in a variety of computer systems proficiently.
  • Ability to navigate a Windows environment, utilize Outlook, and create, edit, save, and send documents utilizing Microsoft Word and Microsoft Excel.
  • Ability to work within a paperless environment.

Requirements

• Respond to phone inquiries from providers, patients, case managers, peer reviewers, and direct to the appropriate handling party.
• Make initial contact for case management staff and providers to obtain clinical information.
• Assist with case management workflow and documentation; prepare routine correspondence for Case Managers, physicians, and patients.
• Identify each caller/patient’s needs and determine the next appropriate action, which may include clinic referral or identifying the necessity for the escalation process to be activated.
• Communicate effectively with all parties, such as case managers, physicians, claims team, and ancillary providers and/or vendors/agencies to ensure that patient information is current, accurate, and complete.
• Print and mail correspondence to all necessary parties in accordance with state rules and regulations.
• Other duties as necessary assigned by supervisor.
• Assist incoming calls to the case management department.
• Monitor dedicated queues/emails.
• Process all determinations and correspondence within 24 hours of receipt.
• Actively participate as a member of the team, working collaboratively with and supporting other staff.
• Complete the assigned deliverable/billable hours per week, as assigned by your Supervisor.
• Identify trends and/or issues in referral patterns and communicate them with management.
• Demonstrate ability to meet administrative requirements, including productivity, time management, and Quality Assurance standards.
• Maintain documentation standards adhering to URAC standards and company policy and procedures.
• Maintain confidentiality - Knowledge of laws and regulations pertaining to HIPAA and PHI.

Benefits

• Professional attire adhering to the Company Dress Code.