Care Management Specialist

Fairview Health Services • Edina, MN

2d

About The Position

The Care Management Specialist is responsible for establishing and maintaining relationships with providers, patients, families, and vendors of Fairview Partners, as well as serving as the liaison between Fairview Partners and the health plans for all community enrolled members. The Care Management Specialist directly supports Fairview Partners Care Coordinators.
This care specialist schedule includes;
80 hours every two weeks
Full time; Day shift
No weekends

Requirements

• Two-year degree in a healthcare-related field or
• Minimum equivalent work experience of four years in a healthcare setting
• 2 years recent experience in a health care setting
• 2 years recent experience with Microsoft Word, Excel, and Access.
• Knowledge of third-party payers, billing procedures and insurance
• Ability to work independently and exercise independent judgment

Nice To Haves

• 4 years experience in a health care setting
• 3 years experience with EPIC, Microsoft Word, Excel, and Access.
• Previous experience with referrals processing in medical office.

Responsibilities

• Serve as a liaison to patients, vendors, providers, and health plan representatives to resolve issues related to billing and health plan referral verification
• Understands the guidelines and processes within each health plan surrounding claims payment for patient referrals.
• Assists case managers or providers with utilization, authorization, and claims payment as appropriate and requested.
• Coordinates and facilitates services as directed by the Care Coordinator.
• Performs, understands, and can explain functions related to the referral process of patients
• Approves/Directs patient referrals to appropriate setting.
• Understands benefit structure of each contracted health plan.
• Communicates directly with vendors, clinics and payers or as needed to patients.
• Responsible for oversight of monthly member reporting
• Reviews health plan member reports for accuracy which ties to monthly capitation payments from health plans.
• Works with the health plans and care coordinators to correct discrepancies and appropriately assigns members to correct care system.
• Utilizes Excel and Access database to report new member information to providers and internal entities of Fairview.
• Coordination of Member Care
• Assists the Care Coordinators in coordinating and ordering services for community members. This includes working with various home care agencies and community agencies to assure the appropriate services have been scheduled.
• Researches community resources for Fairview Partners members and develops relationships with new vendors to utilize their services on an on-going basis.
• Documents member information using EPIC and the Department of Human Services reporting system.
• Monitors and processes changes to member’s health plan status, agency updates, and other internal tracking spreadsheets.
• Assists members in transportation, appointment, and DME & supply requests.

Benefits

• Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more!

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees