Sr. Customer Care Associate (Home Health) at Adventist Health

East Honolulu, Hawaii, United States -

Full Time

Start Date

Immediate

Expiry Date

05 Jun, 26

Salary

0.0

Posted On

07 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Care, Administrative Support, Call Handling, Claims Processing, Pre-certification, Data Entry, Eligibility Review, Medical Records Review, Documentation

Industry

Hospitals and Health Care

Description

Our home health and hospice agencies are located throughout California, Hawaii, Oregon and Washington. They serve the entire community and offer personalized in-home care, and many have been recipients of Home Care Elite awards. So whether you're looking for the buzz of a large city, the tranquility of nearby mountain bike trails or something in between, we encourage you to explore our organization. Job Summary: Provides day-to-day administrative support for the Home Health patients and department. Job Requirements: Education and Work Experience: * High School Education/GED or equivalent: Preferred * Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred * Two years' relevant experience: Preferred Essential Functions: * Handles incoming calls from plan members and healthcare providers for the assigned health plans. Provides information as needed for questions related to medical, dental, vision, and prescription drug claims based upon the benefit descriptions and plan provisions of a variety of group plans. Documents all calls. * Receives referrals and pre-certification requests from providers as applicable. Reviews referral/pre-certifications for proper benefits and eligibility. Enters referrals and pre-certifications data into the computer system. Reviews referrals and medical record information as applicable to facilitate claims department with claims adjudication. Researches and documents rejected or erroneous claims and forwards them for correction as needed. * Performs other job-related duties as assigned. Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein. Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

Responsibilities

This role provides daily administrative support for Home Health patients and the department, primarily by handling incoming calls from plan members and healthcare providers regarding medical, dental, vision, and prescription drug claims based on benefit descriptions. The associate will also receive and review referrals and pre-certifications, enter related data into the computer system, and research/correct erroneous claims.