Care Continuation Specialist
4 weeks ago
MedPOINT Management seeks a skilled Care Continuation Specialist to assist members in continuing care with established physicians. The ideal candidate will work closely with health plans to identify contracted and non-contracted providers, ensuring seamless transitions for ongoing care.
Key Responsibilities:
- Collaborate with health plan coordinators, members, and providers to complete cases
- Work with the Eligibility Team to confirm and upload member eligibility to MPM's system
- Partner with Medical Directors to process denials and assess COC request criteria
- Manage data entry, including creating authorizations from start to end
- Adjudicate and maintain referrals according to Medi-Cal and Medicare timeframes
- Outreach providers to verify demographics
- Work with the Provider Network Team to upload non-contracted providers
- Maintain case history documentation and store case documents
- Support UM teams as needed
- Assist the Client Support Center with high-volume calls as needed
- Regular attendance in UM meetings
Requirements:
- High School graduate or GED equivalent
- 1 year of experience in the medical field
- Knowledge of medical terminology
- Proficiency in Microsoft Office programs, especially Word and Excel
- Proficiency in EZ CAP a plus
- Proficient in English and Spanish
Skills and Abilities:
- Ability to effectively collaborate with all teams across MPM
- Strong customer service skills with good telephone rapport
- Ability to multi-task while remaining adaptable and flexible in a fast-paced environment
- Strong verbal and written communication skills
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