- Collect, verify, and enter claimant data and case information.
- Assist Nurse Case Reviewers with non-clinical issues.
- Data entry of required case demographics including transcription of clinical information.
- Answer incoming group phone calls and interact telephonically with employers, employees, physicians and insurance adjusters to acquire information about medical status.
- Handle phone calls and coordinate medical appointments for members.
- Act as liaison for interpretation of No-Fault and Workers Comp contracts.
- Research provider contract/claim issues received by the provider or the client andperform claims analysis.
- Maintain activity trackers, ensure accurate case verification, and manage documentation.
- Educate providers on policies and act as a liaison for contract interpretation.
- Collaborate with the management team, conduct research on provider issues, and support departmental initiatives.
- Strong PC skills, including Excel.
- Excellent problem-solving and organizational abilities.
- Maintains professionalism under pressure.
- Works well independently and as a team player.
- Requires at least 1 year of experience and a degree (or equivalent experience).
- Bilingual skills are a plus but not required.
- Proficient in medical record review and knowledgeable about the health insurance industry, products, services, claims, and processing.
- Strong in follow-up, negotiation, and managing complex issues.
- Current knowledge of workers compensation and legislative issues a plus.
- Previous experience in case management handling insurance claims a plus.
- Familiarity with medical terminology a plus.
- Strong working knowledge of IMPACT claims system a plus.
- Notary License a plus.
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Care Coordinator - Westbury, United States - MagnaCare
Description
About The RoleREMOTE Support Coordinators handle care management, data entry, and communication with various stakeholders in workers' compensation cases. They provide education and issue resolution for MagnaCare network providers and customers, collaborating to resolve disputes. They also maintain knowledge of policies, working with various departments to address provider issues, reporting to the Casualty Support manager.
The successful candidate will be afforded an opportunity to help further structure this team. This team is a critical component to the delivery of quality healthcare services.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
Primary Responsibilities
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, youll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, youll be encouraged to bring your authentic self to work with all of your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing todays healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning todays challenges into tomorrows solutions.
Come be a part of the Brightest Ideas in Healthcare.
Company Mission
Transform the health plan experience how health care is accessed and delivered by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
DEI Purpose Statement
At BHPS, we encourage all team members to bringyourauthentic selves to work with all ofyourunique abilities. Werespect how you experience the world andwelcome you to bringthe fullness ofyourlived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.
*We are an Equal Opportunity Employer
Annual Salary Range: $40,000 - $50,000
The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a teammember's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal
