Overview:
Now is the time to join us!
Virgin Pulse and HealthComp are now Personify Health. The industry’s first personalized health platform company combines health, wellbeing, and navigation solutions to deliver powerful outcomes to businesses and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.
Responsibilities:
In this role you will wear many hats, but your knowledge will be essential in the following:
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Provide oversight and supervision on the following duties and responsibilities of the triage team. Reports directly to the manager.
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Review referrals to identify possible high dollar concerns and case management needs; upload case referrals for potential case management referrals.
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Stop Loss notification for potential high dollar claims
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Creating cases in the Utilization Management Web.
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Providing admin support to assigned nurses.
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Monitoring cases under high dollar case type; close cases when no further needs are identified.
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Perform data entry and maintain complete and detailed documentation of case information in the UM Web and
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Eldorado computer systems.
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Be sure staff can meet productivity, quality, and turnaround time requirements daily, weekly, and monthly through time management of staff.
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Advanced clerical/administrative duties in the utilization management division.
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Demonstrate a higher level of customer service and understanding of the job
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Serve as a group expert and how to research information on a group
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Serve as a mentor and perform advanced clerical/administrative duties in the utilization management division.
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Assist with planning, organization, and distribution of work; keep team informed of updates and changes in policy or procedure.
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Provide support to manager and efficiently act as backup when manager is out. 
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Assist in special projects, process updates and implementation.
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Train and mentor new and existing intake staff, update, and develop training material as needed.
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Maintain active and positive communication with other departments, brokers, groups, and staff as needed
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Ability to hold staff accountable to their work by working with the manager on process improvement
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Qualifications:
What you bring to the Personify Health team:
In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:
- Associate degree preferred in business, management, or related field.
- Prior experience at HC in intake and triage background 2-3 years.
- Prior experience in customer service and/or medical background.
- Prior insurance and/or claims background.
- Prior experience in a medical front office or hospital patient intake, medical claims processing, or an equivalent combination of education and experience.
- Working at Level II minimum 2 to 3 years with mentoring new hires.
- Proficient in Microsoft suite and Smartsheet with data analytics critical thinking.
You also take pride in offering the following Core Skills, Competencies, and Characteristics:
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Strong written and verbal communication skills.
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Ability to make cold calls
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Proficient in Microsoft Excel, Word, Smartsheet and Outlook
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Ability to organize, prioritize, and multitask in a fast-paced/deadline driven environment
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Demonstrate ability to work independently with excellent judgment
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Accurate data entry skills (40wpm)
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Knowledge of medical terminology; ICD-10, CPT & HCPCS coding desirable.
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Excellent interpersonal and communication skills
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Strong customer orientation
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Require greater than 5 years working in the insurance field in a similar environment
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Teaching and mentoring skills education or experience to provide guidance to staff
No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!
Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.
In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $18.00 - $23.00. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.