Hybrid Data Coordinator/UM Lead na Partnership HealthPlan of California
Partnership HealthPlan of California · Fairfield, Estados Unidos Da América · Hybrid
- Junior
- Escritório em Fairfield
The Data Coordinator/UM Lead will assist the supervisor with daily operations and functions by
providing clerical and technical support in areas of data entry and assist providers with issues or
questions concerning authorization for services.
▪ Provides feedback to UM staff and management team regarding work assignments and
turnaround times.
▪ Able to perform all duties of Coordinator I/II and Authorization Specialist, as required.
▪ Monitors daily attendance line and communicates staffing for delegation of daily
assignments.
▪ Develops staffing update communication to Health Services Department.
▪ Develops Coordinator I/II and Authorization Specialist daily work assignments.
▪ Determines daily work flow and makes changes in order to meet production metrics.
▪ Adjust assignments and call inventory according to hourly or daily need.
▪ Responds to all voicemails and/or escalated calls. Follows up as necessary.
▪ Provides technical support to the UM staff and management team.
▪ Monitors calls and provides feedback to Data Coordinator Supervisor.
▪ Assists UM team in achieving established performance goals and expectations.
▪ Ensures staff has the resources required for completing TAR entry and use of good
judgment.
▪ Enters both manual and electronically submitted data into Partnership systems for RAF
and TAR authorization.
▪ Verifies member eligibility (using the county systems if necessary) when providers are
not able to get an answer from Partnership online systems.
▪ Maintains and updates information for the Partnership claims department when indicated.
▪ Intakes information over telephone from providers for referral and authorizations; refers
clinical issues to nursing staff.
▪ Responds and assists providers with both paper and electronic RAF and TAR inquiries.
▪ Performs general office and clerical duties as needed to support the department; answers
telephones, copies, faxes, files; generates and mails our letters to providers and members.
▪ Monitors TAR process, maintains relevant files and documents.
▪ Maintains tracking system to ensure accurate file maintenance.
▪ Verifies accuracy of information for input to Partnership systems.
▪ Assists Nurse Coordinator, UM or Case Managers as requested.
▪ Responsible for training new staff in use of Partnership systems.
▪ Responsible for on-going staff education in proper use of systems and in Partnership UM
departmental policy and procedures.
▪ Serves as a resource to other departments who have inquiries into the UM process.
▪ Trouble shoots systems and opens tickets with IT and or Work front as necessary to
achieve resolution
▪ Assists with formulation of the new hire onboarding training schedule and trainer
assignment.
▪ Coordinates Coordinator huddles and assists with formulation of staff development
materials and meeting agendas.
▪ Escalates staffing quality, production and or behavior-based opportunities to Supervisor
for follow up.
▪ Manages accuracy and consistent daily completion of DPR.
▪ Cross trains Authorization Specialist to fill in as Coordinator Team Lead as assigned.
▪ Assists claims department by promptly responding to inquiries and E-routes, as needed.
Secondary Duties and Responsibilities
▪ Serves as back-up to other HS support staff during their absence.
▪ Participates in special projects, assignments and tasks as needed.
▪ Fill in for Coordinator Supervisor as assigned.
Education and Experience | High school diploma or equivalent; Associate’s degree or certification
|
Special Skills, Licenses and Certifications | Working knowledge of healthcare and healthcare systems preferred in
|
Performance Based Competencies | Strong written and oral communication skills. Ability to present data in
|
Work Environment And Physical Demands | More than 50% of work time is spent in front of a computer monitor. |
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
HIRING RANGE:
$30.38 - $36.46
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
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