ConnectiCare is a leading health plan in the state of Connecticut. A local company for more than 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. By striving to make it easy for members to get the care they need, ConnectiCare leads the individual market in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance. ConnectiCare is a subsidiary of EmblemHealth.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Summary of Job: To provide operational support to the TPH strategy by performing non-clinical tasks as assigned.
- Works collaboratively, as a critical component of the multi-disciplinary team, to facilitate all TPH processes and activities.
- Enters and approves or pends authorizations for all services and lines of business, upon receipt of inbound utilization management requests, in accordance with departmental policy and regulatory requirements.
- Responds to inquiries from providers, members and ConnectiCare (CCI) employees. Recognizes when it’s appropriate to triage inquiry to TPH clinician for additional review or intervention.
- Performs telephonic triage for TPH prior-authorization ACD line, when assigned. Expectation to meet department ACD Service Level goals.
- Enters and maintains documentation in the TPH platform meeting defined timeframes and performance standards. Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and ConnectiCare standards.
- Initiates completion of approved member and provider correspondence, where appropriate and according to departmental guidelines.
- Generates and distributes daily census and management reports for multi-purpose use.
- Communicates with members and providers regarding member’s authorization status, as required
- Establishes and maintains a process for collecting member-specific clinical and demographic data from providers and other entities when requested by TPH clinical staff.
- Supports communication and coordination with delegated entities, as necessary.
- Actively participates on assigned committees and projects
- Perform other related projects and duties as assigned.
- At least 1-2 years of previous call center or data entry experience in a utilization or care management environment within managed care; Associates Degree or Medical Assistant certification preferred
- Strong oral, written and interpersonal communication skills required.
- Ability to work both independently and collaboratively with others.
- Previous system user experience in a highly automated environment required with strong PC skills required.
- Knowledge of medical terminology, ICD-10 and CPT coding preferred.
- Ability to prioritize multiple tasks.
ConnectiCare is an equal opportunity employer. M/F/D/VConnectiCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.