Intake Agent/LTSS CMA - Remote

Title: Intake Agent/LTSS CMA - Remote

Mandatory skills:

Calls, Call Center,
Microsoft Word, Excel, PC monitor,
Profax, Dynamo, QNXT, Fax, EDI,
medical services, medical review,
medical management services, medical terminology,
Medical, LTSS, URAQ, NCQA,
case management, health care, care management,
benefit plan, care plan, benefits verification, benefits and services,
risk management, regulatory requirements, accreditation requirements,
claim administrators, plan sponsors, member information,
customer service, outbound calls, service delivery, processing transactions

Description:

Position Summary:
Fundamental Components
Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
Utilize Profax, Dynamo and QNXT and other client systems to build LTSS cases, research and enter member information.
Screens requests for appropriate referral to medical services staff.
Coordination of Medical, LTSS including Care Team intake and outreach, screening and supporting care plans.
Approve services that do not require a medical review in accordance with the benefit plan.
Performs non-medical research including eligibility verification, COB, and benefits verification.
Assists Case Managers with coordination of benefits and services.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan Sponsors, and third party payers as well as member, family, and health care team members respectively)
Protects the confidentiality of member information and adheres to company policies regarding confidentiality Communicate with client Case Managers, when processing transactions for members active in this ProgramSupports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
Places outbound calls to providers to gather additional information for authorizations.
Sedentary work involving significant periods of sitting, talking, hearing and keying.
Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.
Working environment includes typical office/ work from home conditions.

Education:
High School diploma, G.E.D. or equivalent experience

Experience:
Background Experience
1-3 years Call Center Experience (preferred, but not required)

Additional Job Information:
Effective communication, telephonic and organization skills.
Familiarity with basic medical terminology and concepts used in care management.
Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
Ability to effectively participate in a multi-disciplinary team including internal and external participants.

VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.

Contact Details :

VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008