Program Coordinator (Call Center)

Location: Pittsburgh, Pennsylvania
Posted On: 11/1/2017
Job Code: 2513_PC_PA
Job Description
Job description
• Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
• Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services.
• Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
• Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.
• Data enter assessments and authorizations into the system.

• High school diploma or equivalent.
• 2-3 years managed care or physician’s office experience. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.

Preferred experience:
• 2+ years call center experience in a managed care of medical environment.

More information about the job
Is Relocation Available?
Is there a bonus structure?
This position is:
New Position
Is there a possibility to work remote?
What is exciting about this opportunity? Supportive culture environment Opportunities for advancement comprehensive fringe benefits

Required skills:
Must Have:
• Must have call center experience managed care or health insurance experience computer/communication skills
• GREAT Communication!
Category:IT  code:new
Job Requirements
call center experience managed care or health insurance experience, computer/communication skills

Not Ready to Apply?
Contact Details
John Jarman
E-mail Address