Program Support Coordinator

Company: Health Plans, Inc.
Location: Westborough
Posted on: May 28, 2023

Job Description:

***$750.00 Sign-On Bonus Available***

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, then HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication-we can't wait to meet you.

What we do

HPI is unique. A respected industry leader that's been serving customers for over 40 years, we're known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you'll contribute to ideas that make a real difference for employers and employees nationwide. There isn't a challenge we won't accept and we're looking for people who have a passion to take it on. Not just a job-a mission.

What you'll do

The Coordinator has responsibility for duties that support the Utilization Management program; the primary task is to intake electronic faxes from providers who are requesting precertification and to initiate the precertification, in a timely manner, in the Care Management system of record. Precertification requests may also be telephonic, and the coordinator may be scheduled for telephonic intake at times. In addition, the Coordinator will also perform a variety of administrative support duties as assigned.

The Coordinator ensures that the precertification is initiated only for services that are a covered benefit per the plan and only when there is a precertification requirement per the plan. The Coordinator will also check high level coverage and network benefit.

In this role, you'll also:

• Initiate precertification and assign to UM Review Coordinator queue
• Complete notification of designated services, when appropriate, as auto-certification;
• Support the UM team by performing necessary administrative duties as assigned
• Support the administrative functions of the Senior Wellness Consultant as assigned
• Refer relevant cases to appropriate clinical programs when completing auto-certification
• Provide timely response to CMS Inquiries
• Adhere to policies and procedures and federal regulations
• Provide excellent customer service to internal and external customers
  
  The ideal candidate has:
  
  • A High School Diploma or equivalent
  • Familiarity with medical terminology
  • Experience in a health care environment
  • Proficient data entry skills
    
    Why choose us?
    
    • Our space is a reflection of who we are-innovative, open and collaborative.
    • Love to get creative? We do too. Let the juices flow and brainstorm in one of our team break-out rooms.
    • We think feeling your best is an important factor in producing great work, so we embrace a "smart casual" dress code and work at ergonomic desks.
    • We offer our employees incredible health coverage, a 401(k), employer-paid disability, EAP, remote work arrangements (depending on the position), and quarterly bonuses.
    • We're a people-first company and value giving back to our community. Ask us about our volunteer opportunities and Service & Giving Program.
    • Need to reenergize? Take a break to chat in the onsite caf, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
      
      So, think you want to join the HPI team? We hope to hear from you!
      
      You can read more about us at hpitpa.com/about-us/careers/
      
      EEO/AA/M/F/Vet/Disability Employer

Keywords: Health Plans, Inc., Worcester , Program Support Coordinator, Other , Westborough, Massachusetts