Job Description
Candidate will be responsible for ensuring that appropriate member treatment plans are followed and proactively identifying ways to improve the health of our members and meet quality goals.
Candidate will be taking inbound calls on a phone queue from members and providers at the Florida Health plan. Additionally, associate will be processing pre-certification requests between calls.
Essential Functions:
- Coordinates follow-up care plan needs for members by scheduling needed appointments or enrolling member in related programs
- Assesses member compliance with medical treatment plans via telephone or through on-site visits
- Identifies barriers to compliance with plans and coordinates resolution to ensure that members receive appropriate level of care in a timely manner
- Researches data to identify opportunities to impact quality goals and makes appropriate process change recommendations
- Makes recommendations to adjust or modify treatment plan and determines need for additional services, in conjunction with case management and provider
- Coordinates identification of and referral to local, state or federally funded programs.
- Coaches members on ways to reduce health risks
- Prepares reports to document case and compliance updates; establishes and maintains relationships with agencies identified in appropriate contract
Qualifications
- HS diploma or GED required
- 3-5 years of related professional experience (preferably in home health or provider setting; medical office or health insurance industry - or any combination of education/experience)
- Excellent attendance
- Pays close attention to detail (will be a lot of written communication – check for accurate spelling, punctuation, and grammar)
- Strong customer service, organizational, and communication skills
- Computer proficient: type 30 WPM
Additional Information
Advantages of this Opportunity:
Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm
Company Description
Company is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.
One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.