• Honesty and Integrity
• Professionalism
• Long-Term Relationships

• Exceed Expectations
• Continuous Improvement
• Success Through Growth

We are eagerly seeking a professional who has the experience below and wants to be part of a positive and productive team. We want you to join us and be part of making a difference every day!! You can be part of “a complete framework for population health transformation”. Together we can transform the healthcare system, while in unison, we create value for everyone involved. Be part of the team!

• Requests medical records from PCP’s, Specialists, Hospitals, etc., related to members activities, as needed.
• Obtain medical records from hospitals and SNF’s
• Assists with COC’s
• Assist team with daily census by entering Face sheets for hospitals and SNF’s
• Attach medical records to authorizations
• Enter referral requests/authorizations in system using ICD 9 and CPT coding
• Monitor Fax Folders
• Contact doctors’ offices requesting additional records
• Creates cases, tasks and completes assessments in Case Management module for all Hospital and SNF discharges.
• Complies with tasks assigned by nurse and, as appropriate, documents accordingly.
• Maintains a case load and contact High Risk members as assigned; follows protocol regarding frequency of contact.
• Maintains documentation on members contacted
• Reach out to members via telephone and meets high risk members in clinic.
• Establishes relationships with members, earns their trust and acts as patient advocate.
• Notifies nurse If members appear to be non-compliant or there appears to be a change in condition
• Assists with outreach activities to members in all levels of Case Management Programs.

• High school diploma or general education degree (GED); with one to three months related experience and/or training; or equivalent combination of education and experience.
  
• Knowledge of ICD9 and CPT codes
• Experience working with IPAs
• Knowledge of Managed Care Plans and medical terminology
• Experience entering referrals and prior authorizations
• Bilingual English/Spanish (preferred)
• Medical Terminology Certificate (preferred_
• Knowledge working in Access Express/Portal, Epic, Essett (preferred)
• Good oral, written and telephone skills

All your information will be kept confidential according to EEO guidelines.