Healthcare Services Coordinator - Aspire Health Plan
Purpose of Position
The Healthcare Services Coordinator is responsible for supervising and directing the support services needed for all Health Services lines of business operations. The Healthcare Services Coordinator will continuously look for ways to improve processes. Contribute to corporate and department objectives by processing all requests in a prompt, professional and courteous manner.
- Oversight and preparation of correspondence, proposals, reports, spreadsheets and forms.
- Assist in maintaining policies & procedures, including editing, proofreading.
- Provide project management assistance as required.
- Answer inbound member and provider calls and assist with authorization and benefit inquiries.
- Coordination and completion of intake/processing for authorization and appeal requests. Perform preliminary review for completeness and appropriate documentation. Triage and escalate to the appropriate clinical resource when needed.
- Utilize knowledge of member eligibility and benefit coverage information to respond accurately to authorization requests, which do not require review/ consultation by a clinician.
- Assist with high-cost case updates.
- Claims resolution management. Coordinate retroactive review process with claims staff and clinical team.
- Coordination of patient specific contracts.
- Provide administrative support to committees chaired by Chief Medical Officer.
- Assist with pharmacy issues in coordination with pharmacy staff.
- Develop excellent professional relationships with our provider and insurance company partners.
- Demonstrate understanding and accurate interpretation to support compliance with regulatory standards, e.g. Medicare Advantage and HIPAA.
- Prioritize and plan work for completion in a timely manner, coordinating with others as needed and meeting deadlines set on all phases of work.
- Maintain a high level of professionalism, safeguarding and preserving the confidentiality of all information in accordance with HIPAA regulations.
- Demonstrate the ability to adapt to changes in the workload and responsibilities.
- Perform other activities and functions as required.
- Minimum A.A. degree or equivalent practical experience in related or similar positions.
- At least five years' experience in a clinical or medical office environment or health insurance customer or provider service experience
- Attention to details in obtaining complete and accurate information
- Ability to key data accurately and rapidly
- Ability to communicate effectively, including written and verbal communication skills
- Basic knowledge of insurance terminology and medical coding, e.g. ICD and CPT
- Ability to operate computer equipment and software programs necessary to fulfill position responsibilities. Efficient use of general office equipment required.
- Working knowledge of Excel and Access, or similar programs and databases.
- Excellent communication skills, both written and verbal.
- Ability to interact professionally with co-workers, providers, clients, brokers and management-level staff.
- Excellent phone manner and ability to handle multiple phone lines.
- Ability to answer questions independently.
- Must be able to problem solve.
- Must be able to meet established deadlines
- BA or BS degree or equivalent with emphasis in Business Administration preferred
- Working knowledge of healthcare policies, procedure and regulations, general office and administrative procedures.
- Business English and/or technical vocabulary related to health care industry (insurance/medical terminology).
Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We’re proud to be a community-centered organization backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Hospital. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It’s the care you need from people you know.
Aspire Health is an equal opportunity employer.