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Data Coordinator/UM Lead

2 months ago

Redding, United States Partnership HealthPlan of California Full time
Overview

To assist supervisor with daily operations and functions by providing clerical and technical support in areas of data entry and assist providers with issues or questions concerning authorization for services.

Responsibilities

  • Provides feedback to UM staff and management team regarding work assignments and turnaround times.
  • Provides technical support to the UM staff and management team.
  • Monitors calls and provides feedback to Data Coordinator Supervisor.
  • Assists UM team in achieving established performance goals and expectations.
  • Ensures staff has the resources required for completing TAR entry and use of good judgment.
  • Enters both manual and electronically submitted data into PHC systems for RAF and TAR authorization.
  • Verifies member eligibility (using the county systems if necessary) when providers are not able to get an answer from PHC online systems.
  • Maintains and updates information for the PHC claims department when indicated.
  • Intakes information over telephone from providers for referral and authorizations; refers clinical issues to nursing staff.
  • Responds and assists providers with both paper and electronic RAF and TAR inquiries.
  • Performs general office and clerical duties as needed to support the department; answers telephones, copies, faxes, files; generates and mails our letters to providers and members.
  • Monitors TAR process, maintains relevant files and documents.
  • Maintains tracking system to ensure accurate file maintenance.
  • Verifies accuracy of information for input to PHC systems.
  • Assists Nurse Coordinator, UM or Case Managers as requested.
  • Accountable to train new staff in use of PHC systems.
  • Responsible for on-going staff education in proper use of systems and in PHC UM departmental policy and procedures.
  • Serves as a resource to other departments who have inquiries into the UM process.
  • Assists claims department by promptly responding to inquiries and E-claims as needed.
SECONDARY DUTIES AND RESPONSIBILITIES
  • Serves as back-up to other HS support staff during their absence.
  • Participates in special projects, assignments and tasks as needed.
Qualifications

Education and Experience

High school diploma or equivalent; Associate's degree or certification in Healthcare is a plus; one to two (1-2) years of data and statistical analysis experience with experience in healthcare utilization trend analysis preferred; or equivalent combination of education and experience.

Special Skills,

Licenses and

Certifications

Working knowledge of healthcare and healthcare systems preferred in managed care and of training/teaching approaches, working knowledge of multiple software package. Working knowledge of PC Windows related applications and familiarity with database applications, typing, and 10-key use. Valid California driver's license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business. Bilingual skills in Spanish preferred.

Performance

Based

Competencies

Strong written and oral communication skills. Ability to present data in a clear and understandable manner. Ability to articulate technical concepts with both technical and non-technical vendors, peers, and trainers. Analytical skills to rationally resolve simple and/or complex problems. Good organization skills to work on multiple assignments simultaneously, prioritize work, and complete projects within established time frames.

Work Environment

And Physical

Demands

More than 50% of work time is spent in front of a computer monitor. When necessary ability to lift, carry, or move manuals and reports, weighing up to 25 lbs. Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. Ability to prioritize workload and initiate action to acquire needed information from professionals by phone. Ability to function effectively with frequent interruptions and direction from multiple team members.

All HealthPlan employees are expected to:
  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 24.12 - $ 29.55

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.