Health Plan Coordinator
3 weeks ago
The Health Plan Coordinator is a vital role at Hillsboro Medical Center, responsible for ensuring seamless patient care through effective insurance plan management.
Key Responsibilities- Process referrals and authorizations for consultations, studies, and procedures in accordance with various insurance plans.
- Obtain authorization for medications with insurance companies, including prescription and infusion medications.
- Coordinate the sample medication program, including receiving medication, updating and reconciling the medication log, and ensuring proper inventory levels.
- Work with patients to find co-pay and drug assistance options.
- Prepare and route medical information to third parties and referral physicians with proper authorization and notation.
- Maintain accurate notations and copies of documents in patient charts.
- Respond to requests for status of referrals and verify insurance eligibility for physician visits.
- Answer and follow-up on telephone inquiries, directing callers to other providers or departments when necessary.
- Triage and document accurately telephone calls from patients, delivering information or requests promptly to the appropriate providers.
- Obtain prior medical records and studies as required.
- Update demographic and financial records for patients, entering information into the computer in a concise and professional manner.
- Respond to correspondence as necessary, by phone or in writing.
- Collect, sort, and distribute mail daily.
- Demonstrate professional appearance and personal conduct.
- Utilize effective communication skills, considering body language, filters, listening, paraphrasing, and questioning with customers of diverse backgrounds.
- Exhibit excellent grammar, spelling, and mathematics abilities.
- Demonstrate exceptional telephone and customer service skills.
- Display effective organization skills and ability to multitask with frequent interruptions.
- Exhibit working knowledge and understanding of medical terminology and insurance authorization processes.
- Understand and apply insurance coverage pertaining to co-payments and referrals.
- Demonstrate personal computer skills, including working knowledge of Word and Excel programs.
- Ensure confidentiality in dealing with patients, patient families, and coworkers.
- Model effective working relationships with healthcare and insurance plan representatives.
- Bilingual in Spanish and English.
Hillsboro Medical Center is an equal employment opportunity employer, committed to providing opportunities for all qualified individuals without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law.
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