Remote with onsite/virtual training. Work from home position after training completion
Position Summary:
This position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services. Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.
Essential Functions and Responsibilities:
1. Meet the Department standard of calls answered, and call documentation entered.
2. Assist Members and Providers with questions and concerns.
Finding Provider(s)/Services for members
Arrange Transportation for members
Answer billing/claims status questions; resolve claim issues for members
Assist with pharmacy issues
Help Members access community support services
Verify member eligibility
Quote benefits
Assist with Referrals
Assist with member health assessments
Assist members with closing gaps in care
3. Ongoing member education.
4. Responsible for all benefits information given to Members and Providers.
5. Participate in Departmental Projects, as appropriate.
6. Coordinate quality improvement initiatives with Medical Management, Provider Relations, and Quality Depts., i.e., Preventative Health Screenings.
7. Other duties as assigned or when necessary to maintain efficient operations of the department and the Company as a whole.
ABOUT THE FACILITY
MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 to help vulnerable populations needing health coverage in Indiana. Our parent organization, McLaren Health Care, is a nonprofit integrated health system who believes all Indiana families should have access to high quality health care regardless of income. Our mission is to provide high quality health care. We only take care of families in Indiana. MDwise works with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.
MDwise has a large network of doctors, specialists and hospitals throughout the State of Indiana. We can help you make wise choices about your health, the health of your family and choosing a medical home. MDwise takes pride in providing Indiana families with quality and affordable health coverage for the whole family.
Further McLaren Specifics:
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