Healthcare Intake Administrator - Flex Schedule after 60 days

Responsibilities

• Administer FH Standard and Expedited Appeals Processes as outlined in Member Handbook/Evidence of Coverage for all products, and in compliance with applicable NCQA standards and other state or federal regulatory requirements.
• Strict adherence to department turn-around time standards established in accordance with regulatory standards is required.
• Act as the initial investigator and contact person for member grievances and appeals, which includes, sending the appropriate acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from the member regarding the grievance/appeal.
• Print, mail, and triage letters at the FH corporate office located at 10 Chestnut Street, Worcester, MA.
• Identifying the need for Personal Representative Authorization form, Medical Record Release Authorization form, or Provider Payment Waiver form and requests such documentation as necessary.
• Assigning case files to the department staff for case management.
• Managing incoming faxes and member specific data, routing to the appropriate staff member.
• Producing, maintaining, and distributing reports/calendars utilized by the team to assist in workload planning.
• Processes department incoming/outgoing mail per established workflows in a timely and accurate manner.
• Providing administrative/clerical support to the department which may include acquisition of medical records from providers.
• Retriving messages from email and voice mailbox, routing to the appropriate staff member.
• Photocopy and compilation of appeal case file when necessary.
• Completion of request for additional information from external review agency.
• Responsible for additional clerical/administrative responsibilities at the discretion of the Director or Manager.
• Providing administrative assistance in support of the Board of Hearings (BOH) process, including preparation of hearing packets, reviewing of materials, as well as tracking and monitoring hearing decisions.
• Ensure that all grievances/appeals are processed in adherence to state and federal regulations (i.e., CMS, MassHealth, OPP), contractual obligations, NCQA guidelines and FH policy.

Qualifications

• College Degree (B.S. or B.A.) or equivalent
• 2 years college education (or knowledge of healthcare field equal to 2 years college preparation)