Care Management Support Assistant
Core
Provides non-clinical administrative support for care management, including processing referrals, verifying benefits eligibility, and coordinating service delivery for members.
Role type
Administrative Care Management Support Assistant
Builds
Referral management workflows and care coordination services for health plan members
Domain
Healthcare administration / Insurance utilization management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical billing knowledge, Medicare/Medicaid criteria understanding, medical authorization processing, CPT/HCPC/ICD-10 code knowledge, HIPAA compliance, customer service
Preferred skills
Home health or infusion pharmacy experience, wound care/ostomy supplies experience, Microsoft Office proficiency, medical billing experience
Technologies
Microsoft Office (Word, Outlook, Excel), software systems for referral processing and benefits verification
Responsibilities
Review inbound referrals and correspondence for processing and resolution; Screen physician orders to verify qualifying medical documentation; Perform verification of benefits coverage and eligibility; Review referral data against medical terms and diagnosis codes; Communicate with patients to confirm demographics and explain service details; Coordinate timely delivery of care with providers; Maintain detailed documentation of patient and provider interactions; Report issues delaying service delivery to manager
Seniority
Entry to Mid-level, hands-on IC