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Suburban Propane
Belchertown, MA, United States
Overview When you join Suburban Propane, you become a part of a fast-paced and dynamic company that has been serving its employees and customers for 90 years. As a Service Coordinator, you will plan and coordinate service installations and repairs for a Customer Service Center (CSC) to maximize productivity standards and address service related in
Job Source: Suburban PropaneMaybury Material Handling
East Longmeadow, MA, United States
Service Coordinator Summary Title: Service Coordinator ID: 1122 Location: East Longmeadow, MA Department: Service Description Maybury Material Handling is looking for a dynamic team player who has a knack for organization and multitasking to join our fast-paced, customer-centric environment. At Maybury Material Handling, we are dedicated to providi
Job Source: Maybury Material HandlingHartford HealthCare
Tolland, CT, United States
Description Job Schedule: Part Time Standard Hours: 32 Job Shift: Shift 2 Shift Details: schedule: 3:00PM - 11:30PM Work where every moment matters. Every day, over 37,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticu
Job Source: Hartford HealthCareHartford HealthCare
Ellington, CT, United States
Description Job Schedule: Part Time Standard Hours: 32 Job Shift: Shift 2 Shift Details: schedule: 3:00PM - 11:30PM Work where every moment matters. Every day, over 37,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticu
Job Source: Hartford HealthCareHartford HealthCare
Ellington, CT, United States
Description Job Schedule: Per Diem Standard Hours: 1 Job Shift: Shift 2 Shift Details: Schedule includes coverage of weekends, holidays and staff PTO on a per diem basis; 3:00PM - 11:30PM Work where every moment matters. Every day, over 37,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowi
Job Source: Hartford HealthCareHartford HealthCare
Ellington, CT, United States
Description Job Schedule: Full Time Standard Hours: 40 Job Shift: Shift 2 Shift Details: Shifts scheduled between 3:00 pm - 11:30 pm Work where every moment matters. Every day, almost 30,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to becom
Job Source: Hartford HealthCareHartford HealthCare
Tolland, CT, United States
Description Job Schedule: Per Diem Standard Hours: 1 Job Shift: Shift 2 Shift Details: schedule includes coverage of weekends, holidays and staff PTO on a per diem basis. Work where every moment matters. Every day, over 37,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment m
Job Source: Hartford HealthCareJRG Partners Inc
Agawam, MA, United States
Company Our client is a growing manufacturing leader of precision machined components serving aerospace, defense, oil, gas, microwave technology, industrial and commercial sectors. Our team is committed to producing the highest quality work using the latest state-of-the-art equipment, technology, and manufacturing methods. The company, which serves
Job Source: JRG Partners IncSpringfield
Job Description Job Description SUMMARY : The Health Services Coordinator acts as the primary resource and contact for providers relating to service requests and correspond with members and providers as to decision(s) made regarding requests for these services. Also assist Case Managers with research and correspondence related to service requests. Adhere to all HNE, HIPAA, DOI and NCQA standards, policies and procedures relating to member confidentiality, documentation, quality, and turnaround times.
ESSENTIAL FUNCTIONS:
Productivity - 40%
Maintains productivity standards for authorization entry, letter generating and auditing
Performs review for out-of-network referrals for applicable plans using set guidelines
Coordinates and authorizes services based on entitled benefits, defined criteria and set guidelines
Pre-screens criteria-based procedures before directing to clinical reviewer
Maintains fully-funded and self-funded queue coverage responding to inbound inquiries from members and providers by providing product and benefit information
Assists in the member appeals process by entering authorizations as appropriate
Understands the concepts, features, benefits, disclosures and provisions of government health insurance programs.
Enters data from Medicare Advantage Health Risk Assessments and forwards to Case Manager for review
Adheres to CMS guidelines and regulations
Assists in response to Prudent Lay Person letters
Assists in claims review by helping to research and resolve complex issues
Provides product, eligibility and benefit information specific to each special account
Ongoing benefit audits for accuracy and error
Internal Customer Support and Education - 40%
First point of contact for all Health Services related benefits and issues
Works collaboratively and cohesively with all members of the CSI Team in order to coordinate a continuum of c care for members consistent with the members’ health care goals and needs
Provides support to Case Managers for trouble-shooting and education
Performs duties and assists supervisor, manager, and Case Manager in administrative functions
Maintains Spark coverage responding to inquiries from respective HNE departments
Provides support and education to Member Services, Provider Relations and Sales Departments including but limited to researching and resolving complex issues, authorization entry for member transactions, response to member inquiries, provide education of health services processes and standards
Processes ASO benefit exceptions as needed
External Member Support and Education - 20%
Provides education on criteria-based procedures to members and physicians
Works as a member advocate promoting a personal and accountable relationship
Makes outbound calls to members to educate them on benefit information
Outreaches to members having called in on the Disease Management Telephone Queue, mailing requested materials, and/or signing up for programs.
MINIMUM REQUIREMENTS:
High School diploma or equivalent and a minimum of 2 years’ experience in a medical administrative role in a physician’s office, clinic or other medical facility or the insurance industry.
Certified Medical Assistant preferred
Experience with and/or specific training in medical terminology
Beginner to intermediate skill level with Microsoft Word and Excel
Typing speed and accuracy
Very good problem solving, organizational and prioritizing skills
Excellent listening skills
Very good ability to effectively interact with a multi-cultural membership
Ability to work independently and as a team member
Ability to communicate effectively with others, on the telephone and in person
May require demonstrated proficiency in self-funded line of business
WORKING CONDITIONS: Works in a standard office-based environment
Health Services Coordinator jobs in Springfield
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