Long Term Support Services Coordinator
BMC Health Net
Job Description Functions as a Senior Care Options (SCO) team member working in collaboration with the SCO Care Management department to ensure timely data entry of authorized Long Term Services and Supports (LTSS) into the Office of Clinical Affairs (OCA) clinical care management documentation system. Reviews and reconciles service events with unmatched claims in collaboration with care management and the claims department. Identifies opportunities for workflow and process improvements related to the LTSS review and authorization processes. Serves as the liaison among SCO UM, CM, and Claims, ensuring there are no gaps in appropriate and necessary care to the SCO membership.
Key Functions/Responsibilities: Completes Utilization Management (UM) notification assessments in clinical care management documentation system and builds prior authorization event. Requests physician orders of services and prescriptions, following up to ensure services have been ordered. Reaches out to service providers to ensure LTSS authorized services have been rendered to the SCO member, documenting in the clinical care management documentation system. Tracks authorization expiration dates, collaborates with care management staff regarding the appropriateness for authorization renewals, and completes renewal authorization event in the clinical care management documentation system.
Monitors the LTSS SCO internal mailbox and follows through on requests and inquiries relative to LTSS services to SCO members; inquiries may be received from the following departments: PA, SCO Customer Care, Pharmacy, Contracting, Care Management, Claims, other. Uses the Electronic Medical Record (EMR) to track durable medical equipment (DME) and medication orders and prescriptions for timely turn-around-time. Serves as point of contact for DME, medications, LTSS service authorizations for the SCO program, collaborating with CM, PA, Pharmacy, Vendor Management, Claims, and Customer Care. May enter MDS assessment into virtual gateway.
Provides excellent customer service. Other duties as assigned Qualifications: Education: Associate’s degree in a Healthcare related field or equivalent combination of education and relevant work experience Experience: At least 2 years of office experience, specifically in either a high volume data entry office, customer service call center, or health care office administration department 2 or more years of healthcare experience Prior customer service experience Computer work experience that required active use of 2 or more software programs Experience Preferred/Desirable: Prior health plan experience Experience with FACETS or clinical care management documentation systems or other, electronic medical records, other healthcare databases Experience with Medicaid/SCO population and LTSS Bilingual skills, fluency in Spanish Certification or Conditions of Employment: Pre-employment background check Competencies, Skills, and Attributes: Ability to use healthcare clinical systems for documentation purposes; ability to effectively navigate systems Excellent customer service and diplomacy skills Ability to successfully collaborate across various functional departments and external constituents such as medical and other service providers Ability to process a high volume of requests with a 95% or greater accuracy rate Process improvement skills Strong oral and written communication skills A strong working knowledge of Microsoft Office products, including Excel Ability to successfully organize and manage projects Detail oriented