Care Management (customer service) Specialized Associate - In Office Elkin, NC

Prism Medical Products • Elkin, NC

85d

About The Position

At Prism Medical Products, we're not just offering jobs-we're building careers! As part of our dynamic team, you'll be empowered to make a meaningful impact every day. Whether you're on the frontlines of patient care, operations, or support services, you'll play a vital role in delivering the innovative and patient-centered solutions that define Prism CARE Solutions. We're searching for motivated individuals to elevate our expertise, support our mission, and help deliver outstanding results. Join us to thrive in a fast-paced, collaborative environment that values growth, compliance, and delivering an exceptional client experience. If you're ready for a fulfilling, long-term career that makes a real difference, we'd love to hear from you! Prism CARES for Our Employees! We don't just say it-we show it. Prism CARES represents our commitment to combining access, resources, and expertise to support our employees while they support our patients and providers.

Requirements

• 6 months of healthcare experience in a medical office setting, preferred.
• A deep understanding of Home Medical Equipment rules and regulations, preferred.
• Ability to develop and utilize cross-functional relationships to facilitate the accomplishment of work goals and objectives.
• Effective verbal and written communication skills.
• Strong attention to detail in composing, typing, and proofing materials, establishing priorities, and meeting deadlines.
• Ability to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands.
• Ability to professionally interact and communicate with individuals at all levels of the organization.

Responsibilities

• Pursues understanding on the intricacies of Case Management Programs within Medicare and non-Medicare payers, Medicaid, Managed Care Organizations, manufacturers, providers, and other suppliers as it pertains to coordination of services for their members/patients, regulatory standards, and compliance.
• Acquires industry knowledge for Medicare, Medicaid, and Commercial payers as it pertains to PRISM core lines of business and any new business opportunities.
• Understands and completes all facets of care management workflow and executes all delegated daily responsibilities in an effective manner to promote optimal efficiencies for order processing.
• Executes all steps of incoming referrals including verification of benefits, supply assessments, order processing, and follow up work for all referral sources in an accurate and timely manner.
• Demonstrates and deploys exceptional phone skills and promotes Prism's brand of client care services for all incoming and outgoing calls while finding resolutions in a timely and efficient manner.
• Ads to all KPI quotas such as phones, verification, order processing and exceptions to meet necessary benchmarks for optimal sales or administration of health plan benefits through excellent problem solving.
• Provides administrative assistance regarding maintenance of private insurance contact cards and promotes high utilization within Billing, Client Operations, Quality Assurance, and Payer Relations.
• Participates in Prism's onboarding program and advanced education as it pertains to Care Management.
• Applies for Certified Training Assistant (CTA) program as a CTA, and successfully completes available leadership development programs to actively mentor PRISM team members company-wide about private insurance and support Training & Development.
• Actively develops their skills and implements protocols to enhance the department's ability to be effective and efficient in delivering the highest level of care for patient referrals.
• Seeks out and promotes extensive knowledge of product offerings and avenues to offer products to the patient that is compliant to our regulatory standards.
• Maintains an excellent attendance record and drives excellent attendance of departmental team members through accountability measures and incentives.
• Ads to all company policies and procedures regarding employment, safety and compliance and report any concerns of non-compliance in any area to your manager immediately.
• Performs other related duties as requested and assigned by Leadership.

Benefits

• Comprehensive health benefits
• Generous paid time off
• 401k matching
• Tuition assistance
• Company-paid holidays
• Employee engagement events

What This Job Offers

• Job Type: Full-time
• Industry: Administrative and Support Services