For more than four decades, CoreSource has crafted integrated, flexible, and tailored employer health plan designs that seamlessly meet specific business needs and delight members. We treat clients as long-term partners – that’s why our average client relationship lasts over 10 years. #GD
Each of our offices around the country is managed locally, by industry veterans who understand the dynamics of the markets they serve. Our responsive and empathetic service teams provide the highest level of support for employers and members. Our local expertise and service is backed by national strength. As an independently operating subsidiary of Trustmark Companies, CoreSource has the support of an A-category rated mutual insurance company.
CoreSource in looking for a Healthcare Management Assistant in our Lancaster, PA office. The Assistant is responsible for providing administrative support for the daily operations of the Healthcare Management Program. The Assistant is responsible to provide exceptional service to both internal and external customers to support the needs of the business and our clients.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Accepts incoming Healthcare Management calls and faxes and determines the reason for the call or fax, which may include determination of precertification requirements, continued stay review, discharge planning, case management referrals, etc.
- Advises callers/fax sender of the utilization management certification requirements based on client information located on the HCM group matrix.
- Offers to connect callers to the benefit department for clarification of plan benefits
- Collects all pertinent demographic information as it relates to the certification of inpatient, outpatient and alternative care sites and enters into the Healthcare Management Information system, documenting per departmental procedures
- Directs calls/fax cases to appropriate RN care manager, utilization management or RN care manager, case management for clinical review and certification
- Initiates outbound calls or faxes to request clinical information and discharge dates
- Responsible for verifying charges-to-date on an individual case and providing appropriate notification and/or referral per current guidelines
- Assists with the discharge call process
- Completes voicemail transcription and maintains accurate statistics related to this process
- Provides telephonic and administrative support for the Case Management, Physician Review and Utilization Management programs and maintains accurate statistics of this process
- Contributes to the development, maintenance and revision of departmental policies, procedures and guidelines
- Provides support to team members to ensure compliance with service standards
- Creates and conducts training of back-up support to perform job functions
- Assists in special projects
- Participates in Quality Improvement initiatives
- Makes recommendations for system development from a user’s perspective
- Assists in the administrative preparation and filing of physician review referrals to contracted sub-vendors
- Responsible for auditing, filing and maintaining complete and accurate physician review records
- Assists with non-clinical information system documentation and determination notification process
- Assists with the orientation of new Healthcare Management personnel and contributes to the ongoing networking of expertise with co-workers
- Acts as a resource for peers and all other associates and clients
- Other duties as assigned
- High School Graduate or equivalent required
- Prior experience in a medical or insurance office
- Ability to communicate in a positive and effective manner in both oral and written communication; ability to speak effectively with clients, physicians, providers, families in crisis and community agencies as well as co-workers and senior management
- Ability to read and interpret documents, criteria, instruction, and policy and procedure manuals; ability to write routine correspondence and reports
- Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals; ability to compute rate, ratio, and percent.
- Ability to apply common sense understanding to carry out instruction furnished in written, oral or diagram form; ability to deal with problems involving several concrete variables in standardized situations; ability to evaluate problems, develop alternative solutions and identify utilization trends and patterns
- Capable of working in an environment that requires organization and prioritization in order to address time sensitive assignments
- Proficient in MS Suite including Word, Excel and Outlook
- Ability to perform multiple tasks simultaneously
- Flexibility; willingness to learn new tasks
- Ability to work in a dynamic team-oriented environment; ability to work independently with minimal supervision or instruction
- Associates Degree preferred
- Previous experience in medical transcription preferred, but not required
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, or disability