Case Management Assistant - Referrals

Tristar Insurance • SC

82d • $18 - $22

About The Position

This is a remote position. The preferred hours would be 9-5:30 PST or 12:00- 8:30 pm EST. This is necessary for later coverage. 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.

Requirements

• High school diploma required
• 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
• Strong communication skills; customer service mindset; team player
• Adheres to professional standards, codes of ethics, system and department policies and procedures
• 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

Nice To Haves

• Medical or Managed Care background preferred
• Certified Medical Assistant

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
• 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

Benefits

• Full Time position
• Remote work flexibility

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees