Summary :

Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence.

Assists in ensuring members are effectively and efficiently managed through the medical / disease management process as needs require.

Within extension of authority, assigns length of stay on acute inpatient admissions, as well as approves specific home health, DME.

Process authorization requests and facilitates referrals. Assists with system letters, requests for information and data entry.

Provides administrative / clerical support to medical and disease management.

Responsibilities :

• Entry level intake (faxed in auth's, calls left on voicemail)
• Select support for Case Manager such as mailings, surveys.
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations, and SNF admissions
• Specified template letters for CM
• Create family files
• Specified callbacks
• Assist HMO with IPA mail authorization forms
• Mail HIPAA forms to members
• Support to Senior / Lead HCS
• Responds to inquiry calls on a limited basis

Education / Requirements :

• Generally, requires minimal experience.
• Generally, requires moderate experience in basic computer functions and software applications

Compensation :

The pay rate range above is the base hourly pay range that Aditi Consulting reasonably expects to pay someone for this position (compensation may vary outside of this range depending on several factors, including but not limited to, a candidate’s qualifications, skills, competencies, competencies, experience, location and end client requirements).

Benefits and Ancillaries :

Medical, dental, vision, PTO benefits and ancillaries may be available for eligible Aditi Consulting employees and vary based on the plan options selected by the employee.