Medical Pre-Certification Intake Specialist

4 weeks ago

Akron, United States OneShare Health Full time

OneShare Health, LLC., based in Irving Texas is a medical cost sharing ministry providing a unique and affordable, ACA-exempt path to healthcare. Our core value is the biblical imperative of giving to and serving others. With industry-leading membership programs and an unparalleled member experience, OneShare Health is passionate about finding ways to fulfill our ministry to members, staff, and other charitable organizations.


At OneShare Health its not just about what we do but how we do it, our core values are the heart of what we do everyday. If you are as passionate about these values as we are, we would love to hear from you


Member-focused - Our members are at the center of all our decisions. We seek ways to continually improve the member experience by serving with empathy, empowerment, and efficiency.

Ownership - We hold ourselves accountable for our own decisions and actions. We welcome constructive feedback to drive constant improvement.

Community - We seek ways to build connection, communication, and compassion among our Members, partners, and employees to make them feel like part of a group with a significant common purpose.


Job Purpose:

The Clinical Support Specialist is responsible for delivering an unmatched member experience through excellence in purpose-driven, customer service. This critical role serves to provide telephonic-based, case-management services by identifying resources, proactively engaging, and assisting members, and providers to navigate the prenotification process.


Job Responsibilities:

  • Responsible for Inbound/outbound calls from Members and Providers.
  • Coordinates care, tracks, and reports on members over the course of treatment.
  • Provides individualized customer service based on unique customer needs.
  • Demonstrates effective, active listening to collect relevant information, build rapport and respond to callers in a professional and compassionate manner with accurate information.
  • Accurately and expediently resolves issues, finds solutions, and provides information to OneShare Health members and providers.
  • Continually meets and exceeds Quality Assurance call audit standard.
  • Ability to educate members about programs and service.
  • Delivers excellent customer service to Member and Providers during the Prenotification process.
  • Responsible for gathering, compiling and submitting member information as it relates to prenotification.
  • Continually utilizes scripts and other reference materials along with internal systems and processes to provide excellent customer service and one-call resolution.
  • Communicates effectively with customers/patients while protecting their confidential health and medication information according to HIPAA and relevant state laws.


Qualifications:

  • High School Diploma/GED required and/or equivalent experience.
  • One (1) Plus years of inbound call center, customer service experience.
  • Two (2) Plus years of experience in case management or care navigation/coordination.
  • Familiarity with databases (AS400) preferred but not required.
  • Familiarity with Salesforce preferred but not required.
  • Bi-lingual (English/Spanish) preferred, not required.
  • Demonstrated ability to effectively multitask.
  • Demonstrated understanding of medical terminology.


Benefits:

  • Generous paid time off
  • 401(k) with employer match
  • Health insurance with employer funding
  • Dental/Vision insurance
  • Employee Assistance Program
  • Paid time for community service projects

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