Program Coordinator II (Technology Specialist)

Job Description

You could be the one who changes everything for our 28 million members as a technology professional on our Medical Management/Health Services team. This is a remote position. Candidates must reside in Texas.

Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.

Responsibilities

• Initiate authorization requests for output or input services in keeping with the prior authorization list.
• Maintain integrity of PHI.
• Maintain working relationships with other departments.
• Research claims inquiry specific to the department and responsibility.
• Attend ongoing training and in-services as directed.
• Perform tasks necessary to promote member compliance such as verifying appointments and obtaining lab results.
• Assess and monitor inpatient census.
• Screen for eligibility and benefits.
• Identify members without a PCP and refer to Member Services.
• Answers phone queues and faxes within established standards.
• Screen members by priority for CM assessment.
• Coordinates services with community-based organizations.
• Attends marketing and outreach meetings as directed to represent the plan.
• Produces and mails routine CM letters and program educational material.
• Assists in the development and coordination of marketing and outreach meetings as directed to represent the health plan.
• Trains new Program Coordinators on system and usage.
• Guides staff regarding benefits, authorization requirements, and policy and procedure.
• Data enters assessments and authorizations into the system.
• Maintains a database as directed.

Requirements

• High school diploma or equivalent; 3-5 years in a managed care setting, medical office, or facility setting with a 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.
• LPN license highly preferred.

Benefits

• Flexible work solutions including remote options, hybrid work schedules, and dress flexibility.
• Competitive pay with a pay range of $21.93 - $37.30 per hour.
• Paid time off including holidays.
• Health insurance coverage for you and your dependents.
• 401(k) and stock purchase plans.
• Tuition reimbursement and best-in-class training and development.