Job Overview. The Network Development Specialist assist in building and sustaining strong, stable provider networks for. all lines of business under Hamaspik Managed Care. This role focuses on closing gaps in the network by. proactively recruiting providers in alignment with organizational access standards and regulatory. requirements. The Specialist will play a critical role in meeting network adequacy goals and ensuring. timely access to care f...
Job Overview. The Member Outreach Specialist is responsible for supporting the department by maintaining departments OVE Calls for our members. And other tasks as assigned. Essential Responsibilities. Completing Required OEV call for all our potential enrollments. Friendly and supportive to members on the phone. Ensuring calls are completed within the 15-day time frame. Encouraging members to complete their AWV and Auto Refills. Provides support ...
Job Requisition. The Utilization Management Coordinator is responsible for supporting the department by coordinating functions and completing administrative telephonic and clerical duties as assigned. Essential Responsibilities. . Create spreadsheets with appropriate data, as requested and assigned. . Provide phone coverage and clerical support to the team. Places follow up telephone calls. . Assists staff within team to facilitate workflow and e...
. Job Summary. The Field Sales Rep is responsible for identifying and engaging seniors who may benefit from long-term care services and Medicare Advantage plans. This is a field-based outreach role focused on building relationships within the community and connecting eligible individuals to available healthcare coverage. This position does not require prior Medicare experience. Training is provided for candidates who demonstrate strong interperso...
Job Overview. The Out of Network Specialist will perform outreach and consistent follow-up to providers to ensure that there are no gaps in network for members and potential members. Essential Responsibilities. Reaching out to providers, talk about plan, member and continuation of care (sales pitch – most of the times, it’s a matter of how we sell the plan, how convincing and clear we are that makes the provider ok with accepting. With the rare e...
The Intake Specialist is responsible for fielding inquiries from potential enrollees and referral sources and assisting potential enrollees with the enrollment process which may include Medicaid applications and recertifications, coordinating benefits and facilitating plan transfers. Essential Responsibilities. Maintains a case load of referrals to be turned into monthly enrollments. Works closely with the Business Development team to ensure time...
We are seeking a detail-oriented and experienced Risk Adjustment Coder to join our dynamic team. The ideal candidate will be responsible for ensuring the accuracy and completeness of clinical data used to support risk adjustment coding for our Medicare plan. You will work closely with healthcare providers and clinical teams to identify and mitigate documentation gaps, ultimately supporting our mission to provide exceptional care to our members. R...
The Intake Specialist is responsible for fielding inquiries from potential enrollees and referral sources and assisting potential enrollees with the enrollment process which may include Medicaid applications and recertifications, coordinating benefits and facilitating plan transfers. Essential Responsibilities. Maintains a case load of referrals to be turned into monthly enrollments. Works closely with the Business Development team to ensure time...
The role of the Member Service Representative provides support and service to members of the Medicare Advantage Plan, by answering questions, resolving issues and educating callers in an accurate, respectful and timely manner. Essential Responsibilities. Deliver high-quality customer service, listening to members’ requests and working to find the appropriate solution by either transferring members to the appropriate departments or assist them the...
Job Overview. The Authorization representative is responsible for the processing of all authorizations and communication with providers in regards to authorizations. This includes sending all authorizations in a timely manner and following up with providers to confirm that necessary authorization has been provided. It involves modifying and updating authorizations as need. The primary aim is to provide the providers with the authorizations needed...
The Intake Specialist is responsible for fielding inquiries from potential enrollees and referral sources and assisting potential enrollees with the enrollment process which may include Medicaid applications and recertifications, coordinating benefits and facilitating plan transfers. Essential Responsibilities. Maintains a case load of referrals to be turned into monthly enrollments. Works closely with the Business Development team to ensure time...
. . . . The Care Manager acts as the sole communicator between member and Plan. Responsibilities include reviewing of person centered service plan with member/members family and coordination of covered and non-covered benefits. Care Manager is responsible for monthly contact and follow up with the members. Potential to work directly with Residences, Adult Homes, etc., and monthly visits to residences with whom they work. Essential Responsibilitie...
