Healthcare Operations Coordinator II
2 weeks ago
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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