- Consistently exhibits behavior and communication skills that demonstrate Tandigm’s commitment to superior customer service, including care and concern for each and every internal and external customer.
- Collaborates with UM Nurses to provide best-practice care coordination and support with the highest level of professionalism and accountability to patients, families, and caregivers.
- Requests clinical information from the medical provider, as appropriate.
- Responsible to answers/monitors all UM calls and the caller to the appropriate teammate and assures coverage of phone lines at all times.
- Maintains a courteous, professional attitude when working with facility staff, providers and their staff, the health plan and co-workers.
- Reviews medical requests with the RN Case Manager, UM Manager and/or Medical Director and other team members as needed and appropriate prior to making any uncertain decisions.
- Acts as a resource to other coordinators, staff, and providers, resolves issues in a timely and efficient manner.
- Provides timely and accurate documentation that is compliant with all established standards.
- Responsible for documenting ICD-10 and CPT coding and levels of care to accurately reflect care and services provided for claim adjudication.
- Participate in internal audit reporting as necessary.
- Actively participates in team meetings.
- Uses, protects, and discloses Tandigm patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Perform additional duties as assigned.
- Minimum: High school diploma, G.E.D. or equivalent.
- Preferred: Associate’s or Bachelor’s Degree.
Minimum: 3 years of professional experience in a customer-oriented setting.
Preferred: 4-6 years of professional experience in a physician practice; hospital; or health plan.
Knowledge, Skills and Abilities
- The self-motivated individual who takes on this rewarding role will have a history of success in project accountability and customer responsiveness; is a team player yet comfortable working autonomously; and is detail-oriented, accurate, and thorough.
- Customer-service oriented; responsive and respectful to colleagues, clients, patients, and providers.
- Excellent communication skills; ability to represent the organization with skill and confidence.
- Demonstrates superior interpersonal skills; the ability to engage and motivate patients, physicians, and service providers telephonically.
- Organized, detailed, accurate.
- Self-motivated and proactive; responds to requests in a timely and efficient manner.
- Collaborative and resourceful; functions successfully in a team environment as well as independently.
- Computer literate with proficiency in Microsoft Office suite of programs.
- Proficient with web-based search engines and software applications, office hardware (phones, fax machines, etc.)
- Ability to type at least 45 wpm.
- Knowledge and familiarity with medical terminology.
- Working knowledge of HMO/managed care/health plans.
Physical Requirements in Accordance with ADA
- Carrying/Lifting: Occasional/0-20 lbs
- Standing: Occasional/Up to 3 hours per day
- Sitting: Constant/Up to 8 hours per day
- Walking: Occasional/Up to 1 hour per day
- Repetitive Motion: Keyboard activity, telephone use, writing
- Visual Acuity: Ability to view computer monitor and read newsprint with or without corrective lenses
- Environmental Exposure: None