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

Prism Medical Products•Elkin, NC

40d•Onsite

About The Position

At Prism Medical Products, were not just offering jobswere building careers! As part of our dynamic team, youll be empowered to make a meaningful impact every day. Whether youre on the frontlines of patient care, operations, or support services, youll play a vital role in delivering the innovative and patient-centered solutions that define Prism CARE Solutions. Were 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, wed love to hear from you! Prism CARES for Our Employees! We dont just say itwe show it. Prism CARES represents our commitment to combining access, resources, and expertise to support our employees while they support our patients and providers. C - Cultivating growth and balance: We empower personal and professional development through comprehensive health benefits, generous paid time off, and a commitment to work-life harmony. A - Access to industry-leading benefits: From 401k matching and tuition assistance to company-paid holidays and employee engagement events, we offer the tools and perks you need to succeed. R - Resources for success: With tailored coaching, professional development programs, and training opportunities, were committed to helping you achieve your goals. E - Expertise and support: Youll benefit from unmatched onboarding, advanced learning resources, and insights developed from real-world experience. Join Our Care Management team at Prism! As a Prism Care Management Associate, youll play a pivotal role in delivering excellence while navigating the fast-paced, ever-evolving landscape of care management. Your work will directly enhance the client experience and ensure patients and providers receive the exceptional care and support they deserve.

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, as well as a keen understanding of industry-related competition and current market.
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 to include, but not limited to, 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.
Adheres 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 and communicates trends or barriers in a timely manner.
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 the 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 from health plans, facilities, and through our e-commerce platform; and troubleshoots all issues to provide resolutions in a timely manner.
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.
Adheres 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.