Contracts Administrator
GuidePoint Security
SFDC
Case Administrator Coordinator
BlueCross BlueShield of South Carolina
full-time
Posted on:
Location Type: Remote
Location: Remote • South Carolina • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Responsible for supporting and maintaining the coordination of daily operations of assigned area.
- Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function.
- You'll be pulling data from multiple Blue Cross systems (Rumba, Blueview, Cohere) and creating detailed reports that summarize member healthcare spending and high-cost claims.
- Maintains the outpatient authorization process to include ensuring benefit coverage, reviewing/determining eligibility, reviewing of established utilization review criteria, interpreting rules/regulations.
- Completes authorization by following established policies/procedures.
- Reviews interdepartmental requests and medical information to complete utilization process.
- Documents process used and decision in the appropriate system in accurate/timely manner.
- Establishes/maintains effective business relationships with primary care physician offices, other providers of health services.
Requirements
- Graduate of Accredited School of Licensed Practical Nursing OR Licensed Vocational Nursing.
- Three years managed care in healthcare, physician's office, OR insurance company setting.
- Ability to work independently, prioritize effectively, and make sound decisions.
- Good judgment skills.
- Demonstrated customer service and organizational skills.
- Demonstrated oral and written communication skills.
- Ability to handle confidential OR sensitive information with discretion.
- Active, unrestricted LPN/LVN licensure from the United States and in the state of hire, OR active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC).
- Microsoft Office.
Benefits
- 401(k) retirement savings plan with company match.
- Subsidized health plans and free vision coverage.
- Life insurance.
- Paid annual leave – the longer you work here, the more you earn.
- Nine paid holidays.
- On-site cafeterias and fitness centers in major locations.
- Wellness programs and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Incentive Plan.
- Merit Plan.
- Continuing education funds for additional certifications and certification renewal.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization reviewdata analysisreport creationbenefit coverage revieweligibility determinationmedical information reviewdocumentationdecision making
Soft skills
independent workprioritizationgood judgmentcustomer serviceorganizational skillsoral communicationwritten communicationdiscretion
Certifications
Licensed Practical Nurse (LPN)Licensed Vocational Nurse (LVN)
