Care Coordinator Job at illumifin
This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility.
RESPONSIBILITIES
1. Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
2. In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
3. Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
4. Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
5. Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
6. Attend case conferences, internally and with the client, to present claims recommendations.
7. Meet quality and production metrics as established and communicated by the department.
8. Other duties as assigned.
Minimum Qualifications
Please Note :
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RESPONSIBILITIES
1. Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
2. In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
3. Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
4. Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
5. Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
6. Attend case conferences, internally and with the client, to present claims recommendations.
7. Meet quality and production metrics as established and communicated by the department.
8. Other duties as assigned.
Minimum Qualifications
- Associates Degree or equivalent formal training program, or 2 years experience in a medical or insurance environment.
- At least 3 years work experience with claims and insurance contract interpretation.
- Intermediate level experience with Microsoft Office products.
- Experience working with healthcare, long-term disability or long term care claims.
- Familiarity with nursing home and home care service providers and service delivery settings
- Excellent verbal and written communication skills.
Please Note :
www.epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.