Senior Care Coordinator
1 week ago
Overview:
Required:
Bilingual (Spanish)
Shift: 9-5:30pm and 10-6:30pm
As a Senior Care Coordinator, you will be responsible for addressing customer inquiries through thorough research and effective communication with relevant departments and client products. You will work collaboratively with both internal and external partners to ensure the resolution of issues. Your role includes managing a comprehensive database for cases, ensuring timely resolution, and maintaining compliance with established standards. You will demonstrate advanced case management skills and leadership capabilities.
Utilize care coordination strategies to address concerns from patients and healthcare providers; secure insurance approvals for designated therapies and proactively plan to prevent delays in coverage by collaborating with patients, families, insurance representatives, healthcare professionals, workplace benefits administrators, and other stakeholders.
You will facilitate the case management process throughout the healthcare continuum and assist with Benefit Investigations as needed. Work closely with the Program Supervisor to manage escalations effectively, taking ownership from initiation to resolution. Participate in the training of new team members and provide refresher training as necessary. Collaborate with leadership to develop training materials and agendas, identify program inefficiencies, and implement best practices.Responsibilities:
Oversee the Care Coordination process within your designated territory. Balance the needs of patients and healthcare providers with the operational requirements of the program. Establish and maintain professional relationships with all internal and external stakeholders (e.g., care coordination colleagues, field teams, patient advocacy groups, insurance case managers, specialty pharmacies, and physician office staff).
Assess the needs of healthcare providers and create action plans to proactively address potential delays in therapy. Coordinate the exchange of patient-related information with all relevant parties (e.g., patients, families, healthcare providers, insurance companies, and specialty pharmacies). Effectively manage a database that includes detailed information on individuals, their insurance coverage, approval statuses, ongoing requirements, and all interactions with patients and providers.
Stay informed about reimbursement processes, billing and coding nuances, insurance plans, payer trends, financial assistance programs, and alternative resources.
Act as the escalation point of contact for the Case Management team, guiding issues from receipt to resolution.
Lead training sessions on program specifics for new hires and conduct refresher training as needed. Collaborate with leadership on documentation updates for training materials and Standard Operating Procedures (SOPs).
Identify and recommend process improvements to enhance operational efficiency. Share knowledge with team members through orientation training, case studies, and consultations for complex cases.
Assist the leadership team with updates and control of SOP/WI documentation.
Qualifications:
Experience in home care management, case management review, utilization review, social service support, insurance reimbursement, and patient advocacy is preferred.
- In-depth understanding of healthcare insurance benefits, relevant state and federal laws, and insurance regulations is highly desired. Experience with data entry and computer literacy is preferred.
- Strong mediation and problem-solving skills. Spanish language proficiency is a plus.
- Ability to manage escalations from beginning to resolution.
- Proficient in all MS Office applications.
A minimum of 2 years of recent experience in the case management process is preferred.
Experience in a hub environment, healthcare claim adjudication, medical benefit handling, specialty pharmacy, third-party billing, and/or provider issues is preferred.
Effective communication skills (oral and written) are necessary.Ability to listen actively and communicate key issues respectfully while understanding the importance of sharing only relevant information. Adaptability to different audiences is essential to ensure clear communication.
Service Orientation
Anticipate, identify, and address the needs of customers and clients, often before those needs are expressed. Actively seek ways to assist others, demonstrating thoughtfulness and empathy. Ensure prompt and courteous responses to customer inquiries and complaints, focusing on enhancing service levels for both external and internal customers.
Process Knowledge
Identify, document, and monitor key processes necessary for achieving successful business outcomes. Map and document processes, develop frameworks for improvement, and recommend enhancements while considering both internal and external implications.
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