Medical Case Manager Assistant / WC Scheduler

Tristar Insurance•Summerville, SC

2d•$18 - $22•Remote

About The Position

This is a remote position. Preference is remote in Texas. The Case Management Assistant 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. This position does not provide any clinical review or decisions. This individual is responsible to ensure the referrals are set up in the Utilization Review/Case Management system and promptly assign to the case manager. Work directly with the Supervisor and Manager to provide additional resources to the case management staff.

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

Nice To Haves

Preference is remote in Texas.
Bilingual English/Spanish preferred.

Responsibilities

Responds to phone inquiries from providers, patients, case managers, peer reviewers and directs to the appropriate handling party
Make initial contact for case management staff
Initial contact with providers to obtain clinical information
Assist with case management work flow and documentation
prepares routine correspondence for Case Managers, physicians, and patients
Identify each caller/patient’s needs and determine the next appropriate action, which may include clinic referral or identifying the necessity for the escalation process to be activated.
Communicates effectively with all parties, such as case managers, physicians, claims team, and ancillary providers and/or vendors/agencies to ensure that patient information is current, accurate, and complete
Prints and mails correspondence to all necessary parties in accordance with state rules and regulations
Other duties as necessary assigned by supervisor
Assist incoming calls to the case management department
Monitor dedicated queues/emails
Process all determinations and correspondence within 24 hours of receipt
Actively participate as a member of the team, working collaboratively with and supporting other staff.
Complete the assigned deliverable/billable hours per week, as assigned by your Supervisor.
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