Medicare Advantage Precert and Case Management Operations Coordinator

The Medicare Advantage (MA) Precert and CM Operations Coordinator primarily supports the administrative functions in the Precert and CM department for MA business. Shares in the responsibility for the daily execution of the utilization management (UM) system batch letter process, scanning all documents as required from the Precert and CM areas received through RightFax or interoffice mail. Responsible for letter review process to include error correction as needed. Coordinates Health Risk Assessment (HRA) activities. Provides administrative support to include backup to the administrative assistant, other non-clinical staff, precert and case management operations coordinator, and clinical informatics systems specialist.

"Upon completion of the initial six-month training period, this position will be eligible for hybrid work. Alternatively, employees may choose to work onsite or in a hybrid capacity (a minimum of 9 days per month onsite), in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

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Why Join Us

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.

• Family Comes First: Total rewards package that promotes the idea of family first for all employees.

• Professional Growth Opportunities: Advance your career with ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.

• Flexibility: options to work onsite or hybrid available

• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
   

Compensation

$20.42–$24.30 hourly
Non-Exempt 11

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you’ll do

• Shares in the responsibility for execution of the daily batch letter generation program from the UM system to include downloading files, online proofreading and correction, printing, file submission to mailroom, scanning/auto capture process, mailing/stuffing case management letters, primary person for processing Medicare Advantage (MA) HRA mailings.

• Shares in the responsibility for scanning all precert, alternative care, case management, prior authorization, or medical review claims related documents for the precert and case management department.

• Responsible for reviewing returned member/provider department generated letters for regeneration manually or from the online file.  Activities include research of member and provider addresses via internal and external resources, referral to other staff members, and/or notation in proper system of the letters return.

• Access RightFax queue, triage faxes received to include moving to BluECM/Imaging, notifying appropriate staff, and documenting in the appropriate systems.

• Shares in the responsibility for typing letters, mail distribution, copying requests, and equipment troubleshooting.

• Shares in the responsibility for creating, coordinating, testing, all activities for letter review to include vendor letters as well as pre/post implementation functions.

• Responsible for tracking HRA documents which may include manual entry in an MS excel document and/or UM system.

• Responsible for coordinating and scheduling meetings to include producing and distributing agendas and meeting minutes.

• Responsible for maintaining current knowledge of precert processes, applicable health plan standards (URAC and State), DOL, CMS, and HIPAA requirements. Provides input for process improvements or changes as needed. Takes responsibility for learning new policies and guidelines, corporate and departmental, as established.

• Must follow URAC standards as required for essential job functions.

What you need

Knowledge/Skills/Abilities

• Must be process ori