Coordinator - Health Services Float Pool

Date: Sep 3, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 4697 

 

Position Summary/Position

 

Under the general direction of the Health Services Manager and Supervisor, the Coordinator - Health Services Float Pool is a high paced position that requires timely processing of requests, verifying eligibility and obtaining additional information as requested by Medical Management or Health Services, and providing administrative or clerical support to the teams within Health Services. This position requires that one be organized, ability to multitask with a working knowledge of Managed Care Operations and Medical Terminology. This position will be assigned to a particular department with the Health Services and is required to float within the Health Services to provide support to the departments as needed. 

Major Functions (Duties and Responsibilities)

 

1. Excellent customer service
2. Monitor the Right Fax Server. Ensure all facesheets, orders, and referrals are processed in a timely manner and timely (ensuring compliance with appropriate turnaround timeframes)
3. Ensure that facesheets, orders and referrals are complete and accurate to reflect current Member demographic information.
4. Meet performance measurement standards for own unit (i.e.: productivity and accuracy for processing of orders/admit facesheets, inpatient authorizations, inpatient service requests, discharges, and referrals at UM Coordinator Level).
5. Communicate with providers/facilities or any external partners as directed by the unit manager/ supervisor/ team leader
6. Assist and provide support to Management or Nurses as requested
7. Assist with placement of IEHP Members to long term care from the community and those transitioning from an inpatient facility
8. Attach reviews and orders into the medical management system for review by the Long-Term Care Review Nurse
9. Performs basic, initial review of the Minimum Data Set (MDS) received on each custodial care Member from the skilled nursing facility
10. Verify eligibility on each Member at the beginning of each month
11. Create authorizations and approval of services
12. Review daily census report in an effort to eliminate duplicates or other admission received from all contracted and non-contracted facilities not required by the health plan.
13. Obtain member discharge dates through daily calls or via census to contracted and non-contracted facilities
14. Ensure that Members receive Home Health or Durable Medical Equipment (DME) items as ordered via phone call and documentation of call within the medical management system.
15. Attach medical records into the medical management system for review by the Grievance or Appeals Nurse
16. Attach Grievance Responses into the medical management system for review by the assigned case owner
17. Call out to Provider/Vendor/Ancillary/Facility offices to confirm GSF receipt
18. Call out to Provider/Vendor/Ancillary/Facility offices to request submission of requested medical records
19. Assist with submission of expedited medical records requests from Maximus IMR (Regulatory Team)
20. Assist with overflow processing of GSF (open/draft/send) for Grievance single case owners (coverage of call outs, PTO time, volume increases)
21. Assist with Acknowledgement Letters overflow processing for Grievance single case owners (coverage of call outs, PTO time, volume increases)
22. Assist with Member call out (bilingual preferred) to inform of Expedite downgrades and right to contact DMHC
23. Assist with Member call out (bilingual preferred) to obtain additional information on Grievances
24. Assist with call out to DME Vendors to confirm receipt of approved equipment (DMHC /DHCS Cases)
25. Assist with coordination of redirection of authorizations as needed on Regulatory and Appeals cases

Experience Qualifications

 

One (1) year of experience as a data entry specialist or coordinator.

Preferred Experience

 

Experience as a data entry specialist or coordinator preferably in an HMO or Managed Care setting.

Education Qualifications

 

High school diploma or GED required.

Professional Certification

 

Medical Assistant certificate preferred.

Knowledge Requirement

 

Requires knowledge of ICD-9/10 and CPT codes. Managed Care or physician office a must.

Skills Requirement

 

Knowledge of computer applications, including word processing, database, and spreadsheets. Good customer service skills.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

While performing the duties of this job, team member is occasionally required to stand; walk; sit; use hands to finger, handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and use taste or smell.  The team member must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. 

 

Hourly pay $18.54

 

Full Time Short Term Assignment up to 6 months to include paid time off, sick time and Holiday pay.

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary. 

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles