Program Coordinator, Associate

1 week ago


Los Angeles, California, United States Blue Shield of California Full time

Your Role

The Social Programs team is responsible for the support, oversight and administration of Social Programs benefits and services ensuring that our eligible members receive appropriate services in-line with benefits and services that is member-centered and in the communities where our members seek care. The Program Coordinator, Associate will report to the Senior Manager, Program Management Clinical. In this role you will play a key role in supporting administrative and operational organization while regularly providing support and assistance to our Providers (Community Health Worker, Enhanced Care Management, Community Supports, and Community Based Adult Service Providers) to facilitate their ability to provide the full scope of the Medi-Cal benefit and/or services to our members.

Your Work

In this role, you will:

Support business objectives, unit processes, and administrative efficiency under the guidance of Program Managers and/or leaders, ensuring that all state and federal rules and regulations are followed Assist in organizing inter-departmental activities and supports operational responsibilities providing administrative/clerical support Review referrals to determine member eligibility for the for Social Programs benefits and services, processing daily service authorizations and denials for requested benefits and services Perform data entry, tracking and case documentation for all members referred for services, including enrollment status, authorizations, encounter data, activities, clinical case records and regulatory reports Follow up with internal staff and providers to support the successful referral and enrollment of members into Social Program's benefits and services Support with reconciling provider claims Facilitate timely Provider submission of deliverables and reports and conduct review of said deliverables and reports to ensure accurate data collection and reporting Support with implementation of training to internal teams, external providers, and community-based organizations by providing ongoing education about the benefits, services and the referral process Conduct outreach calls to members, as needed, to verify engagement in benefits and/or services Perform other assigned duties, as required
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