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Prism Medical Products, LLC · 3 weeks ago

Care Management (customer service) Specialized Associate - In Office Elkin, NC

Elkin, NC

Full-time

Onsite

New Grad, Entry Level

Prism Medical Products is dedicated to building careers and empowering individuals to make a meaningful impact in patient care and support services. The Care Management Specialized Associate will enhance the client experience by executing care management workflows, processing referrals, and ensuring compliance with industry standards.

Health CareMedical

Responsibilities

Pursues understanding on the intricacies of Case Management Programs within Medicare and non-Medicare payers, Medicaid, Managed Care Organizations, manufacturers, providers, and other suppliers as it pertains to coordination of services for their members/patients, regulatory standards, and compliance, as well as a keen understanding of industry-related competition and current market

Acquires industry knowledge for Medicare, Medicaid, and Commercial payers as it pertains to PRISM core lines of business and any new business opportunities

Understands and completes all facets of care management workflow and executes all delegated daily responsibilities in an effective manner to promote optimal efficiencies for order processing

Executes all steps of incoming referrals to include, but not limited to, verification of benefits, supply assessments, order processing, and follow up work for all referral sources in an accurate and timely manner

Demonstrates and deploys exceptional phone skills and promotes Prism's brand of client care services for all incoming and outgoing calls while finding resolutions in a timely and efficient manner

Adheres to all KPI quotas such as phones, verification, order processing and exceptions to meet necessary benchmarks for optimal sales or administration of health plan benefits through excellent problem solving and communicates trends or barriers in a timely manner

Provides administrative assistance regarding maintenance of private insurance contact cards and promotes high utilization within Billing, Client Operations, Quality Assurance, and Payer Relations

Participates in the Prism's onboarding program and advanced education as it pertains to Care Management

Applies for Certified Training Assistant (CTA) program as a CTA, and successfully completes available leadership development programs to actively mentor PRISM team members company-wide about private insurance and support Training & Development

Actively develops their skills and implements protocols to enhance the department's ability to be effective and efficient in delivering the highest level of care for patient referrals from health plans, facilities, and through our e-commerce platform; and troubleshoots all issues to provide resolutions in a timely manner

Seeks out and promotes extensive knowledge of product offerings and avenues to offer products to the patient that is compliant to our regulatory standards

Maintains an excellent attendance record and drives excellent attendance of departmental team members through accountability measures and incentives

Adheres to all company policies and procedures regarding employment, safety and compliance and report any concerns of non-compliance in any area to your manager immediately

Performs other related duties as requested and assigned by Leadership

Qualification

Case Management ProgramsMedicareMedicaid knowledgeCare Management workflowExceptional phone skillsProblem solvingAdministrative assistanceAttendance accountabilityTeam collaboration

Required