Health Support Coordinator

About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have The Health Support Coordinator (HSC) is a member of the Blue Cross Blue Shield of Minnesota (BCBSMN) Care Management (CM) team and is responsible for cross-functional support within the CM department. In this role, the Health Support Coordinator provides moderate to advanced support to CM clinicians with their utilization management, case management, and disease management activities, with the processes currently in place for medical, surgical, and behavioral health. This position will interact with members, providers and other stakeholders .A major responsibility will be to provide customer service to both internal and external customers by telephonic or through written inquiries which typically involve reviewing prior authorizations, admission notifications, concurrent and post-service (pended claim) review requests, program referrals, work queue management, and benefit/eligibility for case management, disease management, and utilization management requests/programs. Work involves learning and assisting with the implementation of new workflow processes, prioritizing and providing referrals to health coaches for member outreach, and providing initial non-clinical triage functions for requests within Care Management. Your Responsibilities • Receive, research, prioritize and respond to Utilization Management, Case Management, Disease Management (UM/CM/DM) requests and program referrals through mailbox management, system work queue management, incoming telephonic and written pre-service, post-service (pended claim), and concurrent care requests. • Outbound calls to providers and facilities as warranted. • Receive and route inbound calls from members, providers, customer service, or other internal stakeholders per process. • Maintain an outstanding level of customer service throughout all points of customer contact. • Ensure the appropriate clinical staff receives the call, or written request in a timely manner and according to established practices, workflow processes, and departmental needs. • Accurately apply specific guidelines, policies, and procedures as authorized by the clinical review areas and in coordination with UM/CM/DM activities. • Research appropriate systems for medical record information and/or pended claims history and prepare medical record information and/or claim to be processed, if appropriate, or set up and assign to clinical review staff. • Check daily activity reports and adjust work priorities accordingly. • Establish and maintain relationships with both internal and external customers. • Provided regular back-up assistance to other team members. • Accept accountability for special projects, assignments or reports that are more difficult in nature and require moderate to complex research, analysis, and documentation skills. • Recognize opportunities for workflow process improvement and initiate workflow changes with leadership. • Cross-trained with demonstrated accuracy in multiple intake and support functions. Required Skills and Experience • 2+ years of related experience. All relevant experience including work, education, transferable skills, and military experience will be considered. • Excellent data entry skills and attention to detail and accuracy. • Demonstrated time management skills. • Abilities to effectively apply and demonstrate workflow instructions and successfully meet turn-around-time expectations. • Good MS Office Suite skills. • Knowledge of mainframe, web-based applications, and populating data in to MS Access databases and other systems/applications. • Strong interpersonal and verbal and written communication skills; ability to express moderate to complex issues to individuals, groups, internal and external contacts, and write clear, concise and grammatically correct materials. • Strong organizational, research, and analytical skills. • Demonstrate decision making and problem solving skills. • Demonstrate the ability to effectively deal with escalated situations. • Positive, professional, service oriented behavior. • High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience • Bachelors or Associate degree. • Current call center environment training and experience. • Working knowledge of BCBSMN products and systems strongly preferred. • BCBSMN Provider or Customer Service experience. • Medicare and Medicaid knowledge. • Claims process experience. Role Designation Teleworker Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite. Compensation and Benefits $21.00 - $23.86 - $28.63 Hourly Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We offer a comprehensive benefits package which may include: • Medical, dental, and vision insurance • Life insurance • 401k • Paid Time Off (PTO) • Volunteer Paid Time Off (VPTO) • And more To discover more about what we have to offer, please review our benefits page. Equal Employment Opportunity Statement At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [email protected]. Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association. Apply tot his job