Job Summary: Responsible for the overall provision of determining benefit eligibility of patients and develop care plans.
DUTIES AND RESPONSIBILITIES:
Demonstrates Competency in the Following Areas:
Provide order fulfillment in the administration of the ONE Programs to include: telephone coverage of customers, data entry of all calls and correspondence, making follow-up phone calls, handling any written correspondence, and other pending ordersservice requests.
Provide verification of eligibility and contractual arrangements for types of services per Health Plan specific direction.
Coordinate all services and care per contractual arrangements, policy, and workflow.
Process beneficiary/patient referrals to provider network, staffing cases with appropriate discipline and agency.
Complete appropriate documentation in designated system for all reviews and tasks associated with staffing a case.
Provide assistance to Providers, health plans, other staff, and referral sources while educating and supporting the Utilization Management program.
Handle any provider/beneficiary/health plan calls.
Participate in on-call after hours/weekend/holidays support for the department as scheduled.
Professional Requirements:
Adheres to dress code, appearance is neat and clean.
Completes annual education requirements.
Maintains regulatory requirements.
Reports to work on time and as scheduled, completes work within designated time.
Wears identification while on duty, uses computerized punch time system correctly.
Maintains client confidentiality at all times.
Attends annual review and performs in services.
Stays current with industry standards by reading/attending educational presentations.
Represents the company in a positive and professional manner in the community.
Actively participates in performance improvement and continuous quality improvement activities.
Attends management meetings, as appropriate.
Ensures compliance with policies and procedures regarding state and federal regulations.
Complies with all organizational policies and procedures.
Communicates the mission, ethics and goals of the company.
Regulatory Requirements:
1+ years of experience in healthcare industry
Positive and professional phone presence
Proficient in Microsoft Office and Windows products
Knowledge of medical terminology
Working knowledge of computerized medical management systems and/or web based programs
Strong interpersonal and communication skills including verbal and written communication
Detail-oriented with the ability to work on multiple, competing, priorities and is extremely organized
Ability to analyze processes and suggest innovative ideas to improve efficiencies
Language Skills:
Able to communicate effectively in English, both verbally and in writing.
Additional languages preferred.
SDL2017
source https://www.jobsinmiramar.com/other-general/pod-coordinator-15e456/
Scott Smith 