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Service/Care Coordinator 2

Company: A-Line Staffing Solutions
Location: Mcallen
Posted on: June 9, 2021

Job Description:

Healthcare Call Center / Service Care Coordinator openings with a major health insurance / managed care company based in the McAllen and San Antonio area! Starting ASAP! Apply now with Luke H. at A-line! Must live in either the McAllen, TX or San Antonio, TX areas Will be WFH/remote during office closures, but need to be okay with going back in when that happens; in Fall 2021 most likely Job Summary: Screen for eligibility and benefits. Initiate DME requests for members by identify the DME payer, DME vendor and submitting a DME referral. Coordinate with DME providers, PCPs and members to ensure DME MD orders are obtained in addition to all clinical documentation required for prior authorization. Perform tasks necessary to promote member compliance such as verifying appointments and assisting with rescheduling appointments and medical transportation. Provide education to member and providers regarding DME benefits and DME requirements. Advocate for member to ensure members receive needed DME item. Follow-up with member to confirm delivery and satisfaction with DME item. Data entry in system for member case reviews. Process authorizations. Review clinical information to determine if medical necessity for item is established. Escalate cases to medical director to determine approval or denial of request. Pay: $18-22 hourly (determined on experience) Schedule: 8am-5pm; Monday-Friday Required: 2-4+ years of relevant health insurance / managed care background with medical billing, prior authorizations, and/or benefit verification experience.Experience wanted with DME and LTSS authorizations.Bachelor' s degree in Social Work, Health Services, Behavioral Science, or related field is highly preferred, OR at least 4+ years of Equivalent/relevant Experience; LVN, OTA, or PTA. LVN preferred (License is the most important).Prefers someone with Clinical Knowledge. (which is why LVN' s have been requested, but for this position and our team someone that is a PTA, OTA, etc. would be acceptable) Why Apply: Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability401k after 1 year of employment: With employer match and profit sharingGREAT Hours! Monday through Friday, 40 hours per week, No WeekendsCompetitive Pay Rate! Keywords: Medical Billing, Medical Coding, Provider Services, Member Services, CMS, Managed Care, MCO, Benefit Verification, DME, Durable Medical Equipment, OTA, PTA, LVN, Licensed Vocational Nurse, Clinical Care, Referral, Provider Services, Provider Relations, Credentialing, HEDIS, STARS, PCP, Clinical Service, Clinical Coordinator, Nurse, Mail Order Medications, CPT, ICD-9, ICD-10, Medical Billing, Medical Coding, Billing & Coding, Insurance Verification, Pharmacy, Prior Authorization, Reimbursement Counselor, Medical Customer Service, Healthcare, Inbound Calls, Outbound Calls, Medicare, Medicaid.

Keywords: A-Line Staffing Solutions, McAllen , Service/Care Coordinator 2, Other , Mcallen, Texas

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