Care Worker

Phoenix AZ 85034

Job Description

This position primarily handles outbound call queues for designated clients related to authorization processing for multiple medical specialties and products. This may include notification calls to ordering physicians, imaging facilities and members, as well as other benefit related calls. This position is held accountable for meeting individual productivity and quality metrics and working with a team to meet compliance and timeliness targets for our clients. This role is cross-trained in inbound functions and provides back up support to Customer Care Associates as required.

Essential Functions


-Contacts referring physician's offices, members and imaging providers via telephone to communicate authorization approvals, denials and appeals information for a wide range of medical products, while maintaining confidentiality.
-Recognizes the compliance and regulatory requirements for each health plan and each medical product and assures actions meet these requirements.
-Contacts referring physician's offices via telephone to verify authorization information, obtain additional clinical information or facilitate a peer to peer consultation between ordering physician and a SBU Physician Reviewer.
-Calls members to support SBU's Facility Scheduling Program.
-Understands the end to end authorization process, SBU's business and business drivers for success.
-Resolves provider or member concerns as the first line of contact.
-Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
-Transfers calls to clinicians and physicians only for clinically escalated situations.
-Processes withdrawals and other case status changes as needed.
-Recognizes and develops relationships with provider groups through repeat calls, and recognizes provider sensitivities for different health plans.
-Responsible for reading and retaining updated account information disseminated through multiple sources. Calls are handled accurately and appropriately per current account information.
-Electronically attaches incoming clinical faxes to authorization requests for medical studies.
-Collects after hours voice messages, researches questions, triages case to the appropriate team and/or return calls as needed.
-Participates in SBU's Customer Care Operations activities as requested that help improve Care Center performance, excellence and culture.
-Supports team members and participates in team activities to help build a high performance team.
-Demonstrates flexibility in areas such as job duties and schedule in order to aid SBU's Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.
-Assists SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
-Assumes responsibility for self development and career progression.
-Responsible for meeting SBU's service standards in all categories on a monthly basis, being a team player, maintaining member and provider confidentiality at all times, demonstrating effective problem solving skills, and being punctual and maintaining good attendance.
-Other duties as assigned by management.

General Job Information

Title

Care Worker

Grade

18

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

11/30/2018

Date Requisition Created

11/29/2018

Minimum Qualifications

Education

GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Knowledge of medical terminology.

-Experience with computer and keyboard use while talking and typing (minimum 35 WPM) simultaneously. Must have an attention to detail skill set.

Minimum 1 year of Customer Service in a healthcare setting.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”