Healthcare Operations Coordinator II

2 weeks ago


Topeka, Kansas, United States Elevance Health Full time

Healthcare Operations Coordinator II

Location: Kansas. This role operates in a hybrid model, combining remote work with office responsibilities. Candidates should ideally reside within a 50-mile radius of the Topeka, Kansas Elevance Health PulsePoint location.

The Healthcare Operations Coordinator II plays a crucial role in delivering non-clinical assistance to healthcare management functions, focusing on more intricate file assessments and addressing inquiries from both members and providers.

Key Responsibilities:

  • Collects clinical data pertinent to cases and identifies the suitable area for referral or assignment (utilization management, case management, quality improvement, medical review).
  • Performs initial evaluations of files to ascertain necessary actions. Maintains and updates tracking systems.
  • Generates reports and meticulously documents all activities. Responds to inquiries, calls, or correspondence within designated scope.
  • Provides general program details to members and providers upon request.
  • May review and support case management activities.
  • Serves as a liaison between healthcare management operations and other internal departments to facilitate the administration of medical benefits.
  • May assist in the case referral process.
  • May collaborate with external community organizations to enhance and coordinate care under the guidance of a Registered Nurse Case Manager.
  • For California Children Services: May request medical documentation from providers and submit CCS referrals to local programs on the same day a potential CCS-eligible condition is identified.
  • Monitors referrals according to established timelines and informs providers and families regarding CCS eligibility determinations and referrals, as well as authorizations and/or deferrals.
  • Responsibilities do not include conducting any utilization management review activities that necessitate the interpretation of clinical data.

Minimum Qualifications:

  • A high school diploma and a minimum of 3 years of administrative and customer service experience are required; or any combination of education and experience that would provide an equivalent background.

Preferred Skills and Experience:

  • Familiarity with managed care or Medicaid/Medicare principles is highly desirable.

For URAC accredited areas, the following professional competencies are expected: Associates in this position should possess strong oral, written, and interpersonal communication skills, along with problem-solving, facilitation, and analytical abilities.



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