Program Support Coordinator (Remote)

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, Health Plans, Inc. (HPI) is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

What you’ll do

The Program Support Coordinator has responsibility for duties that support the Utilization Management program; the primary task is to intake electronic faxes from providers who are requesting precertification and to initiate the precertification, in a timely manner, in the MediWeb system of record. Precertification requests may also be telephonic, and the coordinator may be scheduled for telephonic intake at times. In addition, the Program Support coordinator will also perform a variety of administrative support duties.

The Program Support Coordinator ensures that the precertification is initiated only for services that are a covered benefit per the plan and only when there is a precertification requirement per the plan. The coordinator will also check high level coverage and network benefit. At no time will the Program Support Coordinator be asked to interpret clinical information as part of their role. 

In this role, you’ll also: 

• Initiate precertification and assign to UM Review Coordinator queue
• Complete notification of designated services, when appropriate, as auto-certification. 
• Provide support to the CM team by closely managing inpatient admissions and initiating CM referrals in a timely manner
• Support the administrative functions of the Senior Wellness Consultant as assigned
• Support the UM team by performing necessary administrative duties as assigned
• Refer relevant cases to appropriate clinical programs when completing auto-certification
• Provide timely response to CMS Inquiries
• Complete monthly medical records invoicing
• Adhere to policies and procedures and federal regulations
• Provide excellent customer service to internal and external customers
• Other duties as assigned

What you bring

• High School Diploma or equivalent; an Associate’s degree is preferred
• A minimum of two years’ relevant experience, demonstrating proficiency in telephone techniques and skills
• Experience in the healthcare industry
• Working knowledge of medical and claims terminology
• Proficient data entry skills
• Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Why choose us?

• Our space is a reflection of who we are—innovative, open and collaborative.
• Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
• We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks. 
• Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms. 
• We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
• We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

Benefits

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you!  We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our employees:

• Medical, Dental and Vision Coverage
• Prescription Drug Coverage
• Fitness Reimbursement Benefit
• Tobacco Cessation Program
• Employee Assistance Program
• Flexible Spending Account & Health Savings Account
• 401(k) and Profit-Sharing Plan
• Quarterly Bonuses
• Generous Paid-Time Off 
• Volunteer Days
• Education Assistance & Professional