Medical Health Assistance Coordinator

Job Overview

Healthcase is expanding our team, we are looking for new team member. The role requires communication between medical providers and our client as well as members. The medical coordinator is to coordinate treatment and provide authorizations/issue Guarantee Of Payments for members as well as assist the claims team in the adjudication of medical claims in accordance with company provisions. Respond to inquiries pertaining to authorizations and documentation requirements as well as claim payments and any additional issues that may arise.

Responsibilities and Duties

  • Coordinate and determine approvals, eligibility and inform the medical providers as well as issue GOP’s according to policy and client authorizations
  • Tracking and follow up of the cases in the USA and Latam ensuring appropriate follow up with the medical providers
  • Establishing communication and coordination with medical providers to assist in setting up agreements for our networks
  • Provide guidance, support, and advice to international members seeking medical treatments or procedures
  • Apply all cost containment measures to assist in the claim adjudication process
  • Responds to routine phone inquiries and written correspondence related to authorizations and claims status
  • Screens and routes complex cases to the appropriate manager
  • Proofs claim, review and apply appropriate guidelines, coding, member identification, and processes in appropriate turn-around-time
  • Ensure payments and/or denials are made in accordance with company practices and procedures

    • Qualifications

  • High school diploma/GED required
  • Bilingual/English and Spanish required (French and Portuguese a +)
  • 2+ years of experience in a customer service area or related field company
  • Strong analytical, detail-oriented, and accuracy skills are required
  • Ability to manage time effectively, set priorities, meet deadlines as well as adapt to change
  • Desire to work in a small entrepreneurial environment
  • Healthcare-related insurance experience is a plus

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    Benefits

    Our associates contribute their time, talents, and skills to support our continued success. In appreciation of that commitment, we offer a comprehensive benefits package that supports our associates’ financial, professional and physical wellbeing.
    Among the benefits:

     
    • Competitive pay—both base and incentive
    • Medical, dental and vision insurance
    • Life and disability insurance
    • Paid time off and flex scheduling
    • Career development opportunities that include onsite career coaching