Case Management Assistant - Referrals

Tristar Insurance•Summerville, SC

3d•$18 - $22•Remote

About The Position

Work directly with the Supervisor and Manager to provide additional resources for the case management staff. This position does not provide any clinical review or decisions. This individual is responsible for monitoring incoming correspondence received. The coordinator will ensure the referrals are set up in the case management system and promptly assigned to the case manager. The Referral Coordinator will answer incoming calls, screen, respond and route the calls. This position requires the ability to work independently to meet deadlines, as well as an excellent phone demeanor and a desire to provide exceptional customer service. The position requires knowledge of medical terminology, the understanding of referral criteria by client and/or jurisdictions. The referrals may be for WC Utilization Review and or Case Management services. Responsibilities of the position include, but are not limited to: Set up of member within the case management system Assist incoming calls to the case management referral department Monitor dedicated referral emails to review for new referrals and correspondence Monitor workflow of referrals and identify areas where daily assistance is needed Work with the branch locations and staff to complete and provide necessary information for referrals Process all referrals and correspondence within 24 hours of receipt Maintain daily/monthly referral logs Identify trends and/or issues in referral patterns and communicate them with management. Other duties as assigned Additional Functions and Responsibilities Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards Maintain documentation standards adhering to URAC standards and company policy and procedures Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI Other job duties as assigned

Requirements

High school diploma required.
Medical or Managed Care background preferred and/ or Certified Medical Assistant
Experience in healthcare and or managed care related fields
Minimum of one year of working in a medical or managed care environment preferred.
Medical Terminology preferred.
Experience in healthcare related fields
Strong communication skills; customer service mindset; team player.
Adheres to professional standards, codes of ethics, system and department policies and procedures.
Incorporates the philosophies of continuous quality improvement, customer service and teamwork into daily routine
Excellent typing and keyboard skills (35-40wpm)
Ability to work in a variety of computer systems proficiently
Ability to navigate a Windows environment, utilize Outlook, and the ability to create, edit, save and send documents utilizing Microsoft Word and Microsoft Excel
Ability to work within a paperless environment

Responsibilities

Set up of member within the case management system
Assist incoming calls to the case management referral department
Monitor dedicated referral emails to review for new referrals and correspondence
Monitor workflow of referrals and identify areas where daily assistance is needed
Work with the branch locations and staff to complete and provide necessary information for referrals
Process all referrals and correspondence within 24 hours of receipt
Maintain daily/monthly referral logs
Identify trends and/or issues in referral patterns and communicate them with management
Other duties as assigned
Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
Maintain documentation standards adhering to URAC standards and company policy and procedures
Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
Other job duties as assigned