Member and Provider Notification Coordinator

7 days ago


Los Angeles, United States MedPOINT Management Full time
Job DescriptionJob Description

Summary

The Outpatient UM Member and Provider Notification Coordinator will report directly to Lead/Supervisor. Their primary role is to provide timely notifications to members/providers of a referral authorization and assist the member with specialist appointments.

Duties and Responsibilities

· Maintain knowledge of standard regulations for decision and notification turnaround timeframes for all lines of business (Medi-Cal, Commercial, & Medicare)

· Provide member notification

o Make outbound calls to notify members of a referral/authorization

o Receiving and responding to member inbound phone calls

o Research member’s history for current phone numbers

o Validate current phone and fax numbers for both members and providers

o Actively listen to members and identify their needs

o Assist with scheduling appointments

o Communicate unable to contact (UTC) members to Case Management team with complex care diagnosis i.e. major organ transplant candidate, high risk diagnosis

· Provide Primary Care Physician (PCP) and/or Specialist Care Provider (SPC) notification

o Outreach PCP or SPC for additional medical records for referral/authorization

o Review failed fax report daily

o Outreach SPC when a failed fax has been identified to rectify the providers fax number and re-fax notification

· Document member and provider outreach in EZCAP

· Escalate issues to direct lead as appropriate

· Read and maintain email inquiries

· Collaborate with other departments (i.e. Claims, PNO, etc.) to resolve member/provider matters as needed

· Assist with special projects, as needed

· Assists other team members with their workload, as needed

· Regular attendance at UM team meetings

 

Minimum Job Requirements

· High School graduate or GED equivalent

· One-year medical office experience

· Bilingual

· Knowledge of medical terminology

· Proficiency in Microsoft Office programs, especially Word and Excel

· Proficiency in EZCAP a plus

 

Skill and Abilities

  • Strong customer service skills with good telephone rapport

· Ability to multi-task while remaining adaptable and flexible to fast-paced environment

  • Reliable, dependable, and accountable

· Ability to empathize with complex cases

  • Self-Motivation and ability to work effectively in an independent environment
  • Great critical thinking and problem-solving skills


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