Clerical IV and III

PR range:

• $25-$27/hr. on w2

Length of contract 8 Weeks Is the role remote or on-site? Onsite Confirm job specs in Wand are accurate & Detailed

• Manage Care Dept- Healthcare Experience
• High Standard: Honesty, Professionalism
• Microsoft Office
• Must be proficient in Excel
• Computer Skills
• Analytical Skill
• Effective Communicative Skills (writing, speaking)
• Patient Facing
• Customer Service
• Insurance Verifications
• Filing Skills

Minimum Education Required Required Experience
(i.e tele, med/surg, vents, etc) Specialities Needed Required Certifications
(i.e. BLS, PALS, ACLS) Shift Schedule (i.e 3x12, 5x8) 5x7 Shift Hours (i.e. 7A-7P) 9am-5pm Monday-Friday 1 hour lunch unpaid


Document descriptions:

Provides an understanding of the positions that were assigned to the Managed Care department and each function under each title. By providing a specific as well a general description of the work, skills, and developments of skills if needed to properly run the Managed Care Department tasks.

Managed Care Department Skills:

• High standards and values in professional ethics such as honesty, professionalism, and integrity.
• Understanding of high efficiency of Microsoft 360 Office: Word, Excel, PowerPoint, PDF docs, Outlook/ Webmail, etc.
• Possess high proficiency of analytical skills.
• Effective communicative skills; verbal, writing, and public speaking. Needs to be able to communicate with different stakeholders such as; leadership, providers, payers/representatives, patients, State regulators, and colleagues.
• Understanding the Managed Care concept and the programs and the finance business that represent to Client Medical Center.
• Understanding on Healthcare Management, Public Administration, Public Health, Utilization Management, Return of Investment concept, Value-Based concepts, Medicare Programs, Medicaid benefits, and programs.
• Understanding of concepts and vocabulary such as; members, payer, capitation, reimbursement, care gaps, health inequality, withholding treatment, payers contract, contracted services, Participant, Non-Par payers, NPI, Licenses, NEW York regulation, Standards of Care, Medical Necessity, etc.
• Payer s portals: Anthem, United Healthcare, Healthfirst, Emblem, Metroplus, ADAP, Wellcare, etc.

SUMMARY OF DUTIES AND RESPONSIBILITIES:
Provide high-quality, compassionate, cost-effective coordination of care consistent with our mission to patients regardless of race, color, religion, or ability to pay while obtaining insurance and or financial information from patients and or representatives to determine patient s obligation to the hospital, reports directly to ACM and CM Lvl. A.
General tasks and responsibilities will include:

• Assist the Managed Care team in the provider payer enrollment.
• Assist members in the Client-enrollment process.
• Assist the members with the change of Primary Care Provider in their contracted plans.
• Assist the member with the change in Dental services site/location practice.
• Assist the Managed Care team in the outreach process of the non-user member in a collaborative effort with the practices.
• Assist the Finance Prior Authorization- team in the coordination of services for the members.
• Assist Client in the achievement of the goals and standards of care based on the: CMS, NCQA, PSI, the Joint Commission, Leap Frog Grades, etc.
• Performs other duties as assigned by supervisor.

Skills:
Two years experience

Schedule Start Date:
03/03/2025

Schedule Start Date:
03/03/2025

Schedule Hours Per Week:
40.00

Schedule Hours Per Day:
8.00

Schedule Days Per Week:
5.00