Under the direct supervision of the Director of Managed Care, the Managed Care Representative is responsible for coordinating Managed Care activities to patients, while maintaining a strong focus on patient-centered care, timeliness, quality, and accuracy. Prepares monthly reports, detailing Managed Care activities for the current month and assists with health plan relations and requests. Provides administrative support to the Director of Managed Care and performs independent and collaborative projects as needed.
Schedule is Monday – Friday, working from 8:00am – 5:00pm
Compensation: $22.19 - $23.30 an hour
Golden Valley Health Centers offers excellent benefits including Medical: (0 Deductible / $2,000 Individual; $4,000 Family Out-of-Pocket Max), excellent PPO coverages; Dental; Vision; 403(b) with match, FSA plans, gym discounts, and so much more!
Essential Duties and Responsibilities
- Responsible for Managed Care related activities and day-to-day interactions, including, but not limited to: scheduling appointments for patients, conduct follow-up with patients, and update patient registration information as needed.
- Handles communication to and from patients and health plans regarding Managed Care issues, in a timely and effective manner, and accurately track and document information for all communications.
- Develops and maintains tracking tool for health plan requests, activities, workflows, and projects to ensure work is complete/appropriate, and follow-up is completed.
- Analyze data reports and creates Excel spreadsheets and tables, utilizing functions (formulas) and manipulating the data to retrieve desired information.
- Responsible for producing, validating, and maintaining weekly/monthly reporting related to the ongoing activities of the Managed Care team.
- Demonstrates full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
- Provides support to various internal and external stakeholders to research and resolve Managed Care issues.
- Participates in quality improvement or special projects.
- Attends and actively participates in required meetings as requested.
- Must be able to maintain confidentiality of all information.
- Adheres to the GVHC Mission, Vision, and Values, Standards of Conduct and HIPAA principles.
- Performs other duties as assigned.
Physical Demands
- Lift up to 25 pounds occasionally and push up to 50 pounds (on wheels) on rare occasions.
- Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to clients and staff.
- Must have vision with or without lenses that is adequate to read memos, a computer screen, personnel forms and clinical and administrative documents.
Work Environment
The physical environment requires the employee to work indoors, primarily in an office setting. The noise level inside is quiet to average. Use of general office equipment is required on a daily basis.
Education/Experience Requirements
Minimum Qualifications
- Provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, calm, respectful manner using skills in active listening and problem solving approach.
- Excellent organizational skills, ability to be thorough, accurate, and detail oriented with strong ability to multi-task. Effective interpersonal and communication skills; excellent telephone etiquette; computer knowledge; excellent customer service; excellent verbal and written communication skills; team orientated; proficient with Excel required and knowledge of other Microsoft Office applications; type >40 WPM.
- Uses sound judgment when complications arise outside the scope of authority, such as the need for deadline augmentation, and bringing these to the attention of the supervisor in a timely manner.
- Have flexibility in workload and adjust well with changes, travel to other work site locations as required to perform the functions of the position.
- Valid CA Driver’s License, acceptable driving record, and vehicle insurance.
Education/Experience
- High school diploma or equivalent. Minimum of one (1) year of customer service experience in healthcare setting.
- Minimum one (1) year experience analyzing large amounts of data, preparing/formulating reports through Microsoft Excel preferred.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.