Care Worker - Full-time / Part-time

This position has the primary responsibility (70%) of answering incoming calls from providers and members as they relate to eligibility, benefits, claims, and authorization of services.
o Helping any issues with providers and Authorization requests
o Recognizes this is a frontline service position providing assistance to members and providers regarding programs, policies, and procedures.
o Handling a lot of authorizations/Process Authorizations
o Also responsible for the administrative intake documentation in the appropriate systems.
o Medical Records
o PDF Creator

Essential Functions:
- Researches and provides information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
- Assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
- Documents Customers Comments/information and forwards required information to the appropriate staff.
- Informs providers and members on appeal process.
- Refers callers requesting provider information to Provider Services regarding professional provider selection criteria and application process.
- Links or makes routine referrals and triage decisions not requiring clinical judgment.
- Provides information regarding in-network and out of network provider status, reimbursement rates and states the multiple networks to providers.
- Educates providers on how to submit claims and when/where to submit a treatment plan.

Non-Essential Functions:
One must be customer service oriented, meet Service standards in all categories on a monthly basis, team player, maintain member and provider confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.


Minimum Requirements:
- Education: HS/GED
- Experience: 3 years
- Computer Skills: Must be a proficient typist and able to maneuver through various computer platforms while verifying demographic information on all calls/Data Entry and Excel proficient


Other:
- Excellent verbal and written communication skills. (this team requires for everyone to consistently communicate with each other. They have an internal IM system that they use to keep everyone in the loop.
- Organizational skills required and the ability to handle multiple tasks. (they have multiple screens to work with)
- Must recognize customer service as an ever-changing department, which means one must be flexible in scheduling and able to accept change rapidly.
- Must submit to call monitoring for the purpose of training and quality control.
- Must understand how to take direction well and work with multiple departments

About Aerotek Professional Services:

Join Aerotek Professional Services®. Our customized employment solutions and personalized approach give job seekers access to great opportunities with competitive salaries. Aerotek offers comprehensive benefits that can include medical, dental, optical, and optional 401k. Don't put your career in the hands of just anyone; put it in the hands of a specialist. Launch or rejuvenate your career today with Aerotek Professional Services! Allegis Group and its subsidiaries are equal opportunity employers and will consider all applications without regard to race, marital status, sex, age, color, religion, national origin, veteran status, disability or any other characteristic protected by law.

Customer Service-Uncategorized, Authorizations, EXCEL, DATA ENTRY, PDF, MEDICAL RECORDS, Providers