Position Purpose and Description

Reporting to the Case Management Workforce Supervisor, the Intake Coordinator & Case Management Assistant (CMA) Hybrid role is primarily responsible for managing cases from start to finish. This includes coordinating care, verifying policy benefits, and ensuring a smooth process through close collaboration with the medical team, case managers, and medical advisors. This role also involves providing administrative support to the Case Management team, maintaining accurate records, and serving as a key resource for corporate clients.

Key Responsibilities

1. Case Coordination 

• Support Service Levels: Ensure the Case Management Service Levels are maintained, prioritizing cases according to urgency and necessity.
• Client Services: Coordinate service requests for corporate clients, working closely with Customer Service, Managed Care, and Account Management.
• Provider Coordination: Refer patients to the most appropriate provider based on cost, quality, and availability, particularly for medical consultations and treatments.
• Medical Documentation: Obtain necessary medical information from providers to support coverage decisions, verify treatments meet medical criteria, and set initial, updated, and final reserves.
• Advocate for Patients: Serve as a patient advocate, offering personalized service for corporate clients, including exploring care alternatives if charges exceed Usual, Customary, and Reasonable (UCR) limits.

2. Administrative Support for Case Management

• Communications: Act as a liaison between customers, clients, and providers, obtaining medical and financial information needed for case updates and cost estimation.
• Documentation: Ensure accurate and timely documentation of all communications and case activities in the system.
• Claims Assistance: Provide detailed claims information such as payment status, process dates, and discounts to members, clients, and providers.
• Problem Resolution: Identify potential issues and take corrective actions to avoid escalations, bringing more complex matters to the attention of supervisors when needed.
• Coordination of Medical Appointments: Assist in scheduling medical appointments by contacting multiple providers that meet patients' preferences in terms of location and language.
• Financial Updates: Request financial updates after services are rendered, verify PPO participation, and send Verification of Benefits (VOB) to providers.

Knowledge, Skills, and Abilities (KSA)

• Customer Service Excellence: Demonstrate superior customer service and interpersonal skills.
• Attention to Detail: Be highly organized, detail-oriented, and able to manage multiple tasks simultaneously.
• Professionalism: Maintain a high level of professionalism, especially in problem-solving and decision-making.
• Multitasking: Strong ability to prioritize tasks and manage a heavy workload.
• Communication: Exhibit clear and effective communication skills, both verbal and written, in English and Spanish.
• Team Collaboration: Work well with other departments to ensure seamless case management and customer service.
• Adaptability: Show flexibility and resilience in handling fluctuating volumes and shifting priorities.

Qualifications

• Education: College Diploma (or equivalent); High School Diploma for CMA-related responsibilities.
• Experience: 1-2 years in customer service (Intake Coordinator), 3+ years in Assistance Coordinator or insurance-related roles (CMA responsibilities).
• Language: Bilingual proficiency in English and Spanish, with strong communication skills.
• Technical Skills: Proficiency in Microsoft Office suite and familiarity with health insurance terminology.
• Client Focus: Understand corporate client culture and expectations, with a strong focus on service delivery.

This hybrid role merges critical case coordination functions with administrative support to ensure seamless service delivery and effective case management. The individual must demonstrate a blend of customer service excellence, operational efficiency, and team collaboration, contributing to overall client satisfaction and successful case outcomes.