APS Healthcare is at present recruited Eligibility Specialist on Fri, 19 Jul 2013 21:43:17 GMT. APS Healthcare a subsidiary of Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce...
Eligibility Specialist
Location: Charleston West Virginia
Description: APS Healthcare is at present recruited Eligibility Specialist right now, this position will be placed in West Virginia. Detailed specification about this position opportunity please read the description below. APS Healthcare a subsidiary of Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we p! rovide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs.
Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advantage plans to people with Medicare. We partner with providers in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible.
For more information on Universal American, please visit our website at www.UniversalAmerican.com.
Position Summary:
As an Eligibility Specialist you will verify Medicaid an! d program eligibility for members with requests for Medicaid Health and Behavioral Health services, requiring prior authorization. Follows approved procedures to inform relevant parties of requests that do not meet eligibility and/or program requirements and resolves issues related to such requests.
Essential Functions:
- Reviews and verifies Medicaid and program/service eligibility for prior authorization requests within specified timelines before requests are clinically reviewed.
- Establishes a client record when necessary for fax and telephonic requests.
- Generates necessary notification to inform relevant parties within specified timelines of requests that do not meet eligibility and/or program requirements.
- Handles and tracks queries from providers and members related to program and service eligibility and resolves issues or refers to appropriate parties for resolution within established timelines.
Other! Duties:
- Processes/generates correspondence related to program and service eligibility and prior authorization of services within specified timelines and completes required tracking information.
- Researches, investigates and assists providers to ensure appropriate resolution and tracking of inquiries related to prior authorization status and documents activities per established protocols.
- Documents and logs inquiry and complaint information within established timelines and protocols.
- Other duties as assigned to ensure contract deliverables relevant to eligibility are complete and within required timelines. Assists other departments as necessary to meet contract deliverables.
Education:
- Requires High School Diploma or equivalent
- Associates or Bachelor’s Degree in Human Services Field preferred
Experience:
- Minimum 3 years customer service experience
- Pre! vious eligibility or claims experience in the Medicaid or health care i! ndustry preferred
Knowledge:
- General knowledge of Medicaid medical and behavioral health services
- General knowledge of eligibility verification (Medicaid eligibility and program requirements for behavioral health preferred)
- Knowledge of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes preferred
- Proficient with Microsoft Office Word
Skills:
- Ability to apply Medicaid eligibility and program requirements and APS specific guidelines to demographic data to make valid decisions on program/service eligibility and determine appropriate disposition/notification
- Excellent verbal and written communication skills
- Basic data entry skills
- Excellent customer service skills
- Ability to meet departmental and established workload standards
- Ability to work well with management and team members to contribute to the ! achievement of departmental goals
- Ability to multi-task
- Strong organizational skills
- .
If you were eligible to this position, please email us your resume, with salary requirements and a resume to APS Healthcare.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Fri, 19 Jul 2013 21:43:17 GMT
Apply Eligibility Specialist Here
