Care Management (customer service) Specialized Associate - In Office Elkin, NC

About the role

As a Prism Care Management Associate, you'll play a pivotal role in delivering excellence while navigating the fast-paced, ever-evolving landscape of care management. Your work will directly enhance the client experience and ensure patients and providers receive the exceptional care and support they deserve.

Responsibilities

• Pursues understanding on the intricacies of Case Management Programs within Medicare and non-Medicare payers, Medicaid, Managed Care Organizations, manufacturers, providers, and other suppliers as it pertains to coordination of services for their members/patients, regulatory standards, and compliance.
• Acquires industry knowledge for Medicare, Medicaid, and Commercial payers as it pertains to PRISM core lines of business and any new business opportunities.
• Understands and completes all facets of care management workflow and executes all delegated daily responsibilities in an effective manner to promote optimal efficiencies for order processing.
• Executes all steps of incoming referrals to include, but not limited to, verification of benefits, supply assessments, order processing, and follow up work for all referral sources in an accurate and timely manner.
• Demonstrates and deploys exceptional phone skills and promotes Prism's brand of client care services for all incoming and outgoing calls while finding resolutions in a timely and efficient manner.
• Adheres to all KPI quotas such as phones, verification, order processing and exceptions to meet necessary benchmarks for optimal sales or administration of health plan benefits through excellent problem solving and communicates trends or barriers in a timely manner.
• Provides administrative assistance regarding maintenance of private insurance contact cards and promotes high utilization within Billing, Client Operations, Quality Assurance, and Payer Relations.
• Participates in the Prism's onboarding program and advanced education as it pertains to Care Management.
• Applies for Certified Training Assistant (CTA) program as a CTA, and successfully completes available leadership development programs to actively mentor PRISM team members company-wide about private insurance and support Training & Development.
• Actively develops their skills and implements protocols to enhance the department's ability to be effective and efficient in delivering the highest level of care for patient referrals from health plans, facilities, and through our e-commerce platform; and troubleshoots all issues to provide resolutions in a timely manner.
• Sets out and promotes extensive knowledge of product offerings and avenues to offer products to the patient that is compliant to our regulatory standards.
• Maintains an excellent attendance record and drives excellent attendance of departmental team members through accountability measures and incentives.
• Adheres to all company policies and procedures regarding employment, safety and compliance and report any concerns of non-compliance in any area to your manager immediately.
• Performs other related duties as requested and assigned by Leadership.

Qualifications

To succeed in this role, you should have:

• A strong background in healthcare or a related field.
• Excellent communication and interpersonal skills.
• Strong organizational and multitasking abilities.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite.
• Knowledge of Medicare, Medicaid, and Commercial payer systems.
• Experience with care management workflows and processes.
• Strong problem-solving and customer service skills.