Medical Management Specialist I

  • Full Time
  • Kapolei
  • Posted 1 week ago

Hawaii Medical Service Assn.

Duties and Responsibilities:
  1. Complete intake, triage and/or initial determination for requests by entering data and routing incoming information appropriately using working knowledge of department policies and procedures, plan/program requirements per scripted guidelines and/or claims payment requirements. Maintain productivity rate and meet requirements for accuracy and timeliness.
  2. Answer incoming inquiries by accessing and interpreting data in various computer systems. Provide customers with a high level of service in a business-like and professional manner while conducting appropriate research to resolve inquiries in a timely manner.
  3. Provide education and notification to customers telephonically or in writing regarding the appropriate procedures for Medical Management activities.
  4. Perform various administrative tasks to support Medical Management including but not limited to, receive and distribute incoming mail, ordering of office supplies, filing and photocopying as necessary.
  5. As directed and monitored by the FEP senior case manager in coordination with the Operations Supervisor, conduct limited data collection and client assessment responsibilities in accordance with accreditation and regulatory requirements for the FEP line of business including but not limited to:
    • Screening and preparation of new referrals for case management services by verifying member eligibility and plan structure, using FEP eligibility system(s) and preparing intake information for case assessment and assignment.
    • Creating case files (electronic or hardcopy).
    • On behalf of senior case manager, establishing external contact with members, their families, physicians, and other providers as well as interdepartmental contact within HMSA and completing initial intake and medical information from referral source.
    • Producing member and provider correspondence (e.g. engagement / enrollment into CM services and case closure).
  6. Perform other duties as assigned.
Minimum Qualifications:
  1. Business school graduate and one year customer service experience or an equivalent combination of education and experience
  2. Basic experience in the use of Microsoft Office applications, particularly MS Outlook and Word.
  3. Pleasant telephone manner.
  4. Must be organized, flexible, able to multitask, meet deadlines and document actions clearly and precisely.
  5. Good written and verbal communication skills.