Provides administration and department support for clinical care management, case and disease management and field service coordination staff. Coordinates services and performs administrative functions. Assists in completing activities related to various cross functional projects in support of departmental goals.
DEPARTMENT: Health Services
REPORTS TO: Manager, Care Management
Location: Phoenix, AZ
- Acts as subject matter expert in regards to required departmental best practice, reports and data extract,
- Acts as lead within functional area to identify best practice standardization and facilitates with the group to achieve success of standardization.
- Takes lead on preparing and submitting projects, reports or assignments as needed to meet department initiatives including monthly reports.
- Conducts research, including reviewing claims against member records, and organizes documentation to report findings.
- Responds to phones as assigned or team coverage as directed by Supervisor.
- Provides technical and administrative support to clinical and behavioral staff as needed.
- Serves as a liaison in corresponding and communicating with providers, vendors and WellCare contacts and/or members representative's.
- Produces, formats and edits correspondence and documents.
- Organizes a variety of administrative and clinical tasks and prioritizes in order of importance and impact on members and providers.
- Interacts with other departments including Claims, Intake, Enrollment and Member Services to resolve member and provider issues.
- Participates and supports nursing tasks, including but not limited to: faxes, discharge preparations, request of clinical information, and creation of authorizations if necessary.
- Trains and provides guidance to Care Coordinators.
- Performs special projects as assigned.
- High School Diploma.
- An Associate's Degree preferred
- 4 years experience in an managed care setting, medical office or facility setting with demonstration of medical administration duties.
Special Skills (e.g. 2nd language):
- Knowledge of medical terminology, CPT-4 and ICD-9/10 coding
- Ability to effectively communicate and present information
- Work effectively within group to achieve desired outcomes
- Ability to multi-task
- Solid verbal and written communication skills
- Proficient in Microsoft Office such as Outlook, Word and Excel.