HireOps Staffing, LLC Hiring for Member Enrollment Healthcare – Remote at Dallas, TX Full Time

This position is a contract to hire.

Remote- CST

Pay Rate: $23/hour.

Inbound phone queue is open 8a-8p est (7a-7p cst) Monday – Friday.

Shifts needed will be:

10a-7p cst
7a-4p cst

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.

Education/Experience:

• High school diploma or equivalent.
• 2-3 years managed care setting exp REQUIRED.
• Knowledge of utilization review REQUIRED.
• Claims processing. REQUIRED.
• Medical office or facility setting experience with demonstration of medical administration duties preferred.
• Thorough knowledge of customer service and operation of office equipment such as a personal computer.
• Knowledge of medical terminology.

What previous job titles or background work will in this role?

• Customer Service
• Member Services
• Call Center

Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):

• Worker will be responsible for managing incoming calls presented to the Care Management TFN. Worker will be responsible for enrolling members in Care Management. Worker will be responsible for rerouting misdirected calls to appropriate dept/FTE
• Worker will be responsible for outreaching members to offer and engage in Care Management

Describe the performance expectations/metrics for this individual and their team:

• SLA of 80% or greater
• Average personal call volume meets team average
• Average talk time per call 3-4 minutes
• Calls answered within 30 seconds ring time
• Quality Audit 90% or greater

Outbound PC

• Caseload of 30-35 members per day.
• Member Engagement rate greater than 30%
• Compliance Turn around time – member outreached completed within 7/10 business days depending on referral type/source
• Telephonic Audit Scores of 90% or greater

Tell me about what their first day looks like:

• Morning starts with Zoom meeting with IT for equipment set up. Followed by meet and greet with Supervisor where initial introduction to computer programs/process with occur. Afternoon will include shadowing and training with seasoned Program Coordinator.