Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:

The Assistant Health Coordinator is essential in the relief of administrative tasks of the health coordination team. These administrative tasks must be carried out accurately and timely according to set policy and procedures. This position is a pivitol role in care coordination of our high risk members while providing excellent customer service using clear, concise and understandable written and verbal communication skills. The Assistant Health Coordinator is required to complete assigned duties on behalf of the Health Coordination team in conjunction with MQD and CMS contract requirements as well as AlohaCare business operations requirements.

Primary Duties & Responsibilities:

• Member Outbound Calls – to members to set, reschedule, or cancel appointments for health assessments or in-person visits on behalf of a Health Coordination team member and documenting calls in clinical software system
• Member Incoming Calls – assisting members on behalf of Health Coordination Team
• Authorizations of Home and Community Based Services and Interpreter Services.
  • Building authorization requests from members or at the direction of the Health Coordination team
  • Coordinating or routing authorizations to the clinical team for review and determination
  • Preparing denial letters at the direction of the Medical Director and for review by the clinical team
  • Provider communication of authorization status
  • Monitoring authoriations and denial management to ensure deadlines for timeliness of resolution adherence
  • Mailing member and provider authorization or denial letters
  • Issue resolution

• Fax Management -assist with receiving, distributing, and documenting incoming faxes
• Mail Management - assist with incoming and outgoing departmental mail to include but not limited to:
  • Transportation passes or vouchers to members
  • Informational resource packets to members
  • Health Action Plans to members and providers
  • Other departmental mail needs
• Member Assignments - assist with closing inactive member programs and unassignments between Health Coordinators and/or Community Health Workers.
• Report Coordination - assist with preparation, tracking and maintenance of reports necessary to carry out the functions of the department
• Daily Census Tracking- assist with daily moitoring and notification of in-patient admissions or discharge status for members engaged in Health Coordination
• Referrals for Social Determinates of Health (SDoH) – assist the Health Coordination Team with making referrals to community resources through Unite Us or within neighborhoods.

• Other adminstrative support as needed, for care coordination. Examples include, but are not limited to:
  • Coordination of appointments for members
  • Care coordination actions - create follow up activities for the Health Coordination team
  • Requesting medical records from providers
  • Finding a network or provider specialist
  • Finding appropriate agency for HCBS services
  • Coordinating Durable Medical Euipment (DME)
  • Member Inquiries - as related to assigned task (i.e. confirmation of travel arrangements)
  • Provider Inquiries - as related to assigned task (i.e. making and confirming member appointment)
• Work within our medical management system for care and utilization management (Health Edge) with strick adherence to data entry strategies
• Work within our claims and enrollment system (QNXT)

• Ability to organize, prioritize, communicate and manage workload effectively and efficiently
• Ability to multi-task, and adapt to changing priorities and responsibilities in a fast-paced environment
• Perform other duties and responsibilities, as assigned due to departmental or organizational goals
• Assist with identification and reporting of possible Fraud, Waste, and Abuse cases
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Required Competencies & Qualifications:

• High School Diploma or Equivalent
• 1-3 years of experience as an Administrative Assistant, Medical Office Coordinator, Medical Assistant or Billing and Coding Specialist.
• Equivalent combination of education, experience and course work or demonstrated knowledge of medical terminology, ICD-10-CM, CPT and HCPCS codes will be considered.
• Strong oral, written, and interpersonal communication skills in English, including telephone etiquette
• Requires operation of general office equipment to include; PC, fax/copy machine and ACD Mitel Phones.
• Intermediate skills using Microsoft Office; Word, Excel, Outlook and PowerPoint.
• Achieves results while building trust by communicating in an effective way.
• Ability to multi-task and adapt in a fast-paced environment with focus on quality customer services.
• Ability to analyze and problem solve using critical thinking to make good decisions that contribute to the overall team goal.
• Ability to work as a team member and accept direction.

Preferred Qualifications:

• Previous experience working in the Medical or Health Plan environment
• Word Processing skills of 45-60 wpm with a high degree of accuracy with 10 Key experience

Physical Demands/Working Conditions:

• In office working environment.
• No environmental hazards.
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Salary Range: $19.00 - $22.00 an hour

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.