Program Coordinator II (Technology Specialist)

Job Description

This is a remote position. Candidate must reside in Texas.

Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.

Responsibilities

• Initiate authorization requests for output or input services in keeping with the prior authorization list.
• Maintain integrity of PHI.
• Maintain working relationships with other departments.
• Research claims inquiry specific to the department and responsibility.
• Attend ongoing training and inservices as directed.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.
• Assess and monitor inpatient census.
• Screen for eligibility and benefits.
• Identify members without a PCP and refer to Member Services.
• Answers phone queues and faxes within established standards.
• Screen members by priority for CM assessment.
• Coordinate services with community-based organizations.
• Attend marketing and outreach meetings as directed to represent the plan.
• Produce and mail routine CM letters and program educational material.
• Help develop marketing and outreach meetings as directed to represent the health plan.
• Train new Program Coordinators on system and usage.
• Guide staff regarding benefits, authorization requirements, and policy and procedure.
• Data enter assessments and authorizations into the system.
• Maintain database as directed.

Education/Experience:

High school diploma or equivalent; 3-5 years managed care setting, medical office or facility setting with a demonstration of medical administration duties. Thorough knowledge of customer service, utilization review, or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.

Licenses/Certifications:

LPN license highly preferred.

Benefits

• Flexible work solutions including remote options, hybrid work schedules, and dress flexibility.
• Competitive pay.
• Paid time off, including holidays.
• Health insurance coverage for you and your dependents.
• 401(k) and stock purchase plans.
• Tuition reimbursement and best-in-class training and development.