Care Management Support Assistant
Core
Provides non-clinical support to the assessment and evaluation of members' needs by guiding them toward appropriate care resources and facilitating interactions with providers.
Role type
Care Management Support Assistant
Builds
Referral management and care coordination workflows for home health and infusion therapy services
Domain
Healthcare administration / Insurance utilization management
Required skills
Medical billing knowledge, Medicare/Medicaid criteria knowledge, Medical authorization experience, CPT/HCPC/ICD-10 code knowledge, Home health or Infusion Pharmacy experience, Customer service
Preferred skills
Wound care/Ostomy supplies experience, Microsoft Office (Word, Outlook, Excel), Medical billing experience
Technologies
Microsoft Office, Health Plan contract systems
Responsibilities
Review inbound referrals and correspondence for processing, Screen physician's orders and documentation to verify qualifying medical information, Perform verification of benefits coverage and eligibility, Review referral data against medical terms and diagnosis codes, Provide referral management education to members and providers, Coordinate timely delivery of care with providers, Maintain detailed documentation of patient and provider interactions
Seniority
Entry-level to Mid-level, hands-on IC