Job Information
Highmark Health Associate Care Management Coordinator in Olympia, Washington
Company :
Highmark Inc.
Job Description :
JOB SUMMARY
Perform accurate and timely processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care, based on the benefits for the line of business, and in compliance with the organization's policies, procedures and regulatory requirements. Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures, including review type, clinical information, and decision timeframes. Follow policies and procedures to assure case completion and compliance with state and federal regulatory agencies. Maintain or exceed department standards for call volume, response time and related production and quality measures. May interact with other departments and providers to resolve cases.
ESSENTIAL RESPONSIBILITIES:
Communicate effectively
Proactively inform designated individuals of the status of work assignment to assure decision timeframes and notification requirements are met
Communicate effectively with Utilization Management Staff, providers, other internal and external customers and management
Route Cases Based on Established Guidelines
Provide accurate and timely routing of service requests to the nurse reviewer to assure that the decision and notification timeframes are in compliance with regulatory guidelines
Process service requests meeting established guidelines, and document and route requests that are not permitted
Request additional information verbally and in writing when the information provided is not adequate to make a medical necessity determination
Maintain or exceed department call center standards
Adhere to line of business phone standards to assure regulatory requirements are met
Utilize phone functions to monitor the number of calls in queue and wait time
Utilize daily phone standard reports to assess opportunities for self improvement
Meet or exceed standards for other production and quality measures
Other duties as assigned or requested.
QUALIFICATIONS
Preferred
High School Diploma / GED
Experience in customer service
Experience in typing, keyboard and computer skills
Work experience in medical terminology
Associates degree or certification in a health related occupation
Work experience with ICD-9 and/or CPT coding
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$19.27
Pay Range Maximum:
$26.88
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J263690