About the job
We are seeking a dedicated Healthcare Customer Service Representative/Program Coordinator to join our dynamic team in Pittsburgh. In this role, you will be the vital link between our members and providers, ensuring that individuals receive the appropriate care while offering exceptional support.
Key Responsibilities:
- Receive and manage calls from both members and providers.
- Collaborate closely with the care management team to confirm that members are receiving appropriate care.
- Utilize computer systems to document member interactions and coordinate care.
- Assist with medical and psychosocial aspects of utilization and coordinated care.
- Initiate authorization requests for services in line with prior authorization guidelines.
- Investigate claim inquiries pertinent to departmental responsibilities.
- Perform essential tasks to promote member compliance, including appointment verification and lab result collection.
- Screen members for eligibility and benefits.
- Prioritize members for case management assessments.
- Execute transition of care duties, liaising with the member’s attending physician and relevant healthcare providers.
- Coordinate services with community-based organizations.
- Generate and distribute routine case management correspondence and educational materials.
- Document assessments and authorizations in the system.
Work Schedule: Monday to Friday, 8:00 AM - 5:30 PM