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Form of workPosition Title: Program Coordinator 1 (Remote Work) Locations: Remote CST (Only CST) Anticipated Start Date: 5/9Expected Duration: 9 monthsJob Type: Contract with potential to extendShift: 9a-6pmPay Rate: $24.00/hr on W2.Need: Prior Call Center , Scheduling and Peer - Peer Experience.
Job Description:Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
• Receiving requests for peer to peer and review if they meet the criteria.
• Trucare and outlook are main platforms that this person would be responsible to work within
• Taking calls for peer to peer based on denial letter that are generated.
• On average this person would be handling inbound / outbound calling (20 calls approximately per day, or more)
• This person will be taking live calls that are queued in
• Fast paces environment
• Ability to work in highly productive environment
• Team is ever evolving; this person must be able to go with the flow and adapt
Describe the performance expectations/metrics for this individual and their team:
• Quality and Quantitively with Productivity.
• Would be given a goal and would be expected to meet after training takes place.
• This person must be able to send out Microsoft Calendar Invite.
Tell me about what their first day looks like:
• Review of the systems and work the team is completing
• Ensuring the new hire has access to the various systems
• Centene University Training
Required Skills/Experience:
Call center experience
Professional phone skills
Microsoft Outlook
Strong documentation, grammar, writing skills
Healthcare background
Preferred Skills/ Experience:
Previous peer to peer experience
Scheduling experience
Education Requirement: High School Diploma
Education Preferred: College
Education/Experience: High school diploma or equivalent. 2-3 years managed care setting, medical office or facility setting with demonstration of medical administration duties. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.
For Illinois Youth Care contract: Required Education/Experience - Bachelors Degree in nursing, social sciences, social work, or a related field. 1 year supervised clinical experience in a human services field.
For Oregon plan only: A valid driver's license is required.
* Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility.
* Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
* Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the members attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
* Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.
* Data enter assessments and authorizations into the system.
Benefits:BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.About BCforward:Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.
Interested candidates please send resume in Word format Please reference job code 221230 when responding to this ad.
