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This job was posted by https://joblink.maine.gov : For more information, please see: https://joblink.maine.gov/jobs/1090835

\"Who We ArePoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.Job SummaryRespond to provider queries, enter administrative authorization data into the computer system, and maintain proper documentation and files to support care of members, customer service, and other departmental functions. Enters all referral/data information into the computer system, maintains proper documentation and facilitates coordination of services. The position will be directly associated with incoming referrals and authorizations for the utilization component of medical management.Key Responsibilities/Duties what you will be doingReceive incoming authorization requests from providers, via telephone queue line (or other means) and obtain necessary administrative information and work to resolve non-clinical issues [such as checking on authorization status or claim question].Clinical calls will be triaged to a care manager.Contacts provider offices for further details on referrals, if necessary. Researches member eligibility and primary care selection to complete entry of referral and precertification event.Documents and maintains all telephone calls and enters a note on each call/inquiry made. Documents all admissions, and referrals. Maintains flow and storage of information such as messages, forms, and logs.Aids the clinical staff by requesting discharge dates, updates on Home Health Care referrals, updates on post-acute inpatient referrals, VNA, CSP, and/or other necessary information.Working with providers and other members of Clinical Services to solve complex and urgent issues.Ensures that appropriate person/department from across the organization is appropriately involved with applicable issues.Data entry of Authorization Requests for all Inpatient stays Outpatient requests as needed, into information system and send out authorization letters to facilities/offices.Identify any outliers and triage to care manager for review.Performs other duties as assigned.Represents Medical Management at applicable activities including system user groups and other health data system organizations.Attends organization-wide meetings and department staff meetings.Maintains professional growth and development through self-directed learning activities and involvement in professional, civic and community organizations.Exhibits exceptional internal and external customer service skills.Ability to work in clinical and company databases.Other duties as assigned by the Intake and Outreach Coordination leadership.Qualifications what you need to perform the jobEDUCATION: (Minimum education required)Associates Degree or equivalent relevant work experience preferably required;EXPERIENCE: (Years of experience)Two plus years of experience in a business environment required, managed care/health industry environment experience preferred.SKILL REQUIREMENTS: (Include interpersonal skills)Excellent verbal and written communication skills generally acquired through college or other advanced education is required.Must be able to demonstrate proficiency and accuracy in performing data entry tasks in multiple applicationsIndividual must be able to appropriately identify urgent situations and ollow the appropriate protocol.Position also requires the ability to manage multiple priorities as well as having the initiative, judgment and perception to operate independently and in a partnership with other departments.Individual must possess strong organizational and problem solving skills and the attention to detail necessary to act within this complex environment.Requires excellent interpersonal skills.Position requires daily contact, by telephone, with network providers and their office staff, hospital contacts and Tufts Health Plan internal departments.WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)Fast paced office environment handling multiple demands.Must be able to exercise appropriate judgment as necessary.Work is done in an open cubicle office setting with other employeesRequires ability to sit for long periods of time performing data entry functionsCONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, departmen