Responsible for proactively managing all outbound calls to patients, providers, and health plans in order to coordinate timely delivery of patient medication. This position requires the highest level of communication competence coupled with the highest professional demeanor. Must have extensive knowledge as it relates to eligibility, benefits, billing, claims, prior authorizations, financial programs, operational policies and procedures. In addition, must have a clear understanding of Health Plan and provider policies and procedures. Responsible for assessing the callers needs and providing solutions or triaging it to the appropriate department or individual as needed. Additionally responsible for all tasks and documentation required to manage patients medical and insurance information as it relates to setting the patient up for service and delivery.
Manages all fill opportunities by making proactive outreach to patients, providers and health plans.
Actively listens and identifies caller needs.
Researches and provides timely solutions to caller with a high degree of professionalism.
Inquiries may include but are not limited to: Health Plan inquires, Provider inquires, Non clinical product related inquires, Benefit inquires, Billing inquires, Policy and Procedure inquires.
Assists with the sourcing and maintenance of patient profiles including but not limited to patient demographics, insurance information, Rx information and provider information to ensure patient records are complete and accurate.
Assists Intake and Exceptions teams with the sourcing of needed documentation including new Rx and prior authorizations to minimize the risk of shipping delays.
Coordinates with billing team to provide claim, billing and collection information as needed. May run test claims to ensure payment prior to dispense.
Assists Customer Care Associates and provides guidance with complex issues.
Assist with the execution on call out projects for new clients or lines of business.
Other duties and special projects as assigned by operations manager and department supervisor.
Preparing delivery tickets and supply items.
Managing Queue maintenance.
Active participation in training programs.
Coordination of manufacture replacements.
Rescheduling of deliveries due to uncontrollable events.
Other Job Requirements
Responsibilities
Must understand medical terminology and diagnostic codes.
Experience with insurance verification and healthcare benefits assessment.
Strong communication skills, both verbal and written.
Proficient with MS Office Suite, specifically Excel.
Basic knowledge and experience in home care, mail order, or specialty pharmacy.
General Job Information
Title
Patient Outreach Coordinator
Grade
19
Work Experience - Required
Customer Service
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
