Description:Position SummaryFundamental ComponentsPerforms intake of calls from members or providers regarding services via telephone, fax, EDI.Utilize Profax, Dynamo and QNXT and other client systems to build LTSS cases, research and enter member information.Screens requests for appropriate referral to medical services staff.Coordination of Medical, LTSS including Care Team intake and outreach, screening and supporting care plans.Approve services that do not require a medical review in accordance with the benefit plan.Performs non-medical research including eligibility verification, COB, and benefits verification.Assists Case Managers with coordination of benefits and services.Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan Sponsors, and third party payers as well as member, family, and health care team members respectively)Protects the confidentiality of member information and adheres to company policies regarding confidentiality Communicate with client Case Managers, when processing transactions for members active in this ProgramSupports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.Places outbound calls to providers to gather additional information for authorizations.Sedentary work involving significant periods of sitting, talking, hearing and keying.Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.Working environment includes typical office/ work from home conditions.EducationHigh School diploma, G.E.D. or equivalent experienceExperienceBackground Experience1-3 years Call Center Experience (preferred, but not required)Additional Job InformationEffective communication, telephonic and organization skills. Familiarity with basic medical terminology and concepts used in care management. Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. Ability to effectively participate in a multi-disciplinary team including internal and external participants.Notes:M-F 8-5Fully remote (never coming onsite)VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status
Description:Position SummaryFundamental ComponentsPerforms intake of calls from members or providers regarding services via telephone, fax, EDI.Utilize Profax, Dynamo and QNXT and other client systems to build LTSS cases, research and enter member information.Screens requests for appropriate referral to medical services staff.Coordination of Medical, LTSS including Care Team intake and outreach, screening and supporting care plans.Approve services that do not require a medical review in accordance with the benefit plan.Performs non-medical research including eligibility verification, COB, and benefits verification.Assists Case Managers with coordination of benefits and services.Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan Sponsors, and third party payers as well as member, family, and health care team members respectively)Protects the confidentiality of member information and adheres to company policies regarding confidentiality Communicate with client Case Managers, when processing transactions for members active in this ProgramSupports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.Places outbound calls to providers to gather additional information for authorizations.Sedentary work involving significant periods of sitting, talking, hearing and keying.Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.Working environment includes typical office/ work from home conditions.EducationHigh School diploma, G.E.D. or equivalent experienceExperienceBackground Experience1-3 years Call Center Experience (preferred, but not required)Additional Job InformationEffective communication, telephonic and organization skills. Familiarity with basic medical terminology and concepts used in care management. Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. Ability to effectively participate in a multi-disciplinary team including internal and external participants.Notes:M-F 8-5Fully remote (never coming onsite)
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