HSS Job Title: Program Coordinator
Company Job Title: Program Coordinator 1

Working with Hiring Manager Arminda Morgado Garcia and Staffing Specialist Dakharia Hemphill

Req: 138750-1

No Griffin

Vaccination NOT REQUIRED
# of Openings: 1 pos, 2 sub spots

If Contract, Length of Assignment: 3 month project based, potential to extend
MU or BR: 40% MU
Compensation Notes: $18.50 to $18.50 an hour
Location: Remote in Texas, CST (McAllen preferred)
Shift: 8:00am – 5:00pm (subject to change depending on business needs) Possibly with 2 hrs a day of over time according to business needs.
Start Date: ASAP
Interview Times/Interviewer: Zoom w/ Alicia Moore, Arminda Morgado Garcia & Julie Martinez
Minimum Education/Licensures/Qualifications:
Please include city/state on resume

2 years of medical experience in authorizations or claims processing practices in managed care setting.
Knowledge of customer service, medical terminology, and operation of office equipment. (Please list on relevant skill set for shortlisting purposes if they have it)
Microsoft Outlook, Skype for Business, Zoom, Microsoft Word, Microsoft Excel, SharePoint, Internet - Please list on resume which they have experience with for shortlisting
HS Diploma or GED

Preferred but not a must:

MCO experience

Types of Candidates to Submit to Sales Rep:
Best Candidate: Referral/Authorizations/Claims Specialist with 2+ years in managed care
Second Best Candidate: Program/Scheduling Coordinator with 2+ years in managed care
Third Best Candidate: Referral Specialist with 2+ years from busy Dr. office/hospital setting

Day to Day Duties:
The Centralized Authorization Team consists of the processing of authorizations for LTSS, in which we are now at a 6-7 BD TAT for the processing of Ltss/ SK/SH/MMP authorizations. We will utilize project temps/contingent workers to assist with each of these areas as well as cross train them to be able to assist in multiple functions. The authorization team continues to experience a high task and authorization volume as the number of VIP providers has increased.

Describe the performance expectations/metrics for this individual and their team:

Excellent attendance (especially during training)
Daily goals are being met
Daily production trackers must be completed and emailed to designated person at the end of your shift
Multi-tasking with multiple monitors and applications
Utilize work guides and or resources
97% Quality (Audits)
98% Production
0-5% Error Rate

Tell me about what their first day looks like:

Welcome call from Supervisor
Centene University Training Courses
Shadow mentor via zoom screen share (only if training courses are completed)

What previous job titles or background work will in this role?
2+ years of experience in a Managed Care Organization environment or working with people who have disabilities and/or with vulnerable populations who have chronic or complex conditions. Other state specific requirements may apply.

Sample Resumes:

Jeniffer Mendoza
Location: Pharr, TX
Interview Availability: Mon-Fri 8-5

SKILLS

Bilingual Medical Office Specialist/ Billing and Coding Specialist with a background in billing, collections, records, maintenance, and appointment setting
Experience ICD-9 & ICD-10
HCPCS Coding Guidelines Work Office Professional
Insurance and collections knowledge
Types more than 45 wpm
Office support (phones, faxing, filing) Microsoft Office/ Excel knowledge

Work Experience:
St. Michael’s Ambulance - Edinburg, TX
August 2019 to Present
Office Manager/ customer service

Provided assistance to clients
Assisted customers in person
Created customer appointments
Inventoried stock
Operated the cash drawer
Confirmed payments, refunds, etc. do medical reports, also assist with embroidery in making company shirts, etc.

Maximus Call Center - Edinburg, TX
December 2017 to August 2019
Customer Service Representative

Answer incoming calls for 211-the health and human services commission.
Attend clients in knowing what benefits are active, denied, help them apply and/or give ways to re-apply.
Transfer client’s to assigned locations, file complaints, appeals, report changes, etc.

Doctor's Hospital at Renaissance
May 2013 to December 2015
Registration Representative

Registers patients for all services, ensuring patient demographics and account information is appropriate for patient account type as determined by patient’s visit.
Responsible for clearly explaining authorizations/pre-certifications, and/or benefit memos on patient accounts to ensure expeditious billing and to protect the financial standing of the facility.
Performs eligibility and benefits verification and re-verification applicable to patient’s visit. Uses utmost caution that authorizations and pre-certifications are correct and as accurate as possible to avoid rejections and/or denials.
Maintains a current and thorough knowledge of utilizing online eligibility and pre-certification tools made available

Education
High School Diploma, Premier High School - Pharr, TX 2009

Ruby Chavez

Edinburg, TX

Interview Availability: after 11am CST

No Time Off Needed

Relevant Skill Set:

Over 6 years of experience as a Customer Service Representative in the healthcare field
Handled an average of 35-40 inbound and outbound calls
Background includes handling prior authorizations and insurance verification, explaining member benefits, working directly with medical insurance plans
Experience in a metric-driven fast-paced call center environment
Bilingual in Spanish and English
Proficient in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint)

Professional Experience:

American Family Insurance
February 2022 to February 2024

Bilingual Customer Service Representative

Handled inbound calls from members regarding their insurance
Explained member benefits
Handled insurance verification

Humana – Remote
March 2021 to February 2022

Customer Service Representative

Technical support for rewards program
Inbound calls from members regarding rewards
Handled customers web and log in issues
CRM to navigate members health coverage

Prime Therapeutics – Remote
October 2019 to June 2020

Pharmacy Technician

Data Entry, rejected pharmacy claims were processed by pharmacy tech and sent out to appropriate teams to either deny or approve claims
Handled prior authorizations and insurance verification
Multitask between Microsoft programs and use company specific applications

T-Mobile – Mission, TX
August 2018 to March 2019

Associate Expert

Handled billing questions and disputes
Processed refunds and credits

Medtronic – Chanhassen, MN June 2017 to June 2018

Client Care Representative

Answer inbound calls and outbound calls to follow up with patients
Handle emails from Medtronic employees and Clients in regard to troubleshooting
Assist Patients and Client’s with troubleshooting of Medtronic’s telehealth devices and software
Worked directly with medical insurance plans

Education:

Glencoe Silver Lake High School - Glencoe, MN GED

Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.

Education/Experience: High school diploma or equivalent. 2-3 years managed care setting, medical office or facility setting with demonstration of medical administration duties. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.

For Illinois Youth Care contract: Required Education/Experience - Bachelors Degree in nursing, social sciences, social work, or a related field. 1 year supervised clinical experience in a human services field.

For Oregon plan only: A valid driver's license is required.

• Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the members attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
• Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.
• Data enter assessments and authorizations into the system.

Comments
McAllen area candidates
Medical experience required
5/2/2024 1:57:15 PM - Hemphill, Dakharia - Please submit to new and updated candidates

Contract - Patient/Member Services

$19/hr

About this job

Facility details

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