What are the responsibilities and job description for the Intake Coordinator position at Perform RX?
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com .
Work Arrangement
· This is a remote position.
Responsibilities:
This position is responsible for ensuring that all problems, complaints, grievances and appeals, presented by Plan members/participants or their representative, are documented and forwarded to the Grievance Coordinator in accordance with established policy and procedures, National Committee for Quality Assurance, and Federal/State guidelines. The Intake Coordinator interacts with the member/participant or their designee to confirm understanding of the complaint/grievance, acknowledge the complaint/grievance both written and verbally and enhance the understanding of policies and procedures for complaints, grievances and appeals.
- Assist member/participant or their designee in filing a formal complaint and/or grievance.
- Coordinates and acknowledges all member and provider appeals and grievances, including the member grievances, appeals, requests and disputes.
- Successfully transmits all complaints, grievances and appeals received from other areas into the system for the Grievance Coordinator and assigns cases using correct protocol
- Prepares, develops and presents written case summaries for all adverse determination for the purpose of conducting State Fair Hearings when asked.
- Actively seeks the involvement of the area leadership whenever necessary, for clarification and supporting documentation.
- Documents, in the appropriate computer system, all correspondence with a member and or a provider related to an appeal or grievance issue.
- Uses sound judgment and discretion when communicating findings related to an appeal. When necessary, will obtain authorization for release of sensitive and confidential information.
- Remains up to date with rules, regulations, policies and procedures relating to Plan member benefits, member’s rights and responsibilities, and Complaints and Grievances and appeals
- Maintains the performance standards.
- Follows up when compliance standards are not met.
- Adheres to Plan policies and procedures and supports the mission and values of Plan
Education/ Experience:
- High School Diploma/GED required. Associate’s Degree preferred.
- A minimum of two (2) years work experience in a Managed Care environment and knowledge of the basic health care industry, managed care principles and medical terminology preferred.
- Intermediate level of proficiency and knowledge of Windows and Microsoft Office applications, including Excel, Access, PowerPoint and Outlook.
- Experience in grievance/appeals environment preferred.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
