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Restricted Recipient Support Coordinator Senior Job

Date: Dec 26, 2018

Location: Eagan, Minnesota, US, 55122

Company: Blue Cross and Blue Shield of Minnesota

About Blue Cross



At Blue Cross and Blue Shield of Minnesota, we are developing industry-leading strategies every day that make a healthy difference in people’s lives. Blue Cross has a legacy of improving health through innovation because we believe that everyone should have the opportunity to live the healthiest life possible. Chartered in 1933 as the state’s first health plan, we’ve been serving the health care needs of Minnesotans for more than 80 years.



Blue Cross supports you with competitive pay and a comprehensive benefits package. Many Employee Resource Groups are active in the company, promoting inclusion and helping us meet the diverse needs of our workforce and our members. Join us, and enjoy a work environment where all employees are respected and valued — a workplace honored with a perfect score on the Human Rights Campaign Corporate Equality Index for 2017. Find your place at a company that cares.



 


Description Summary

The Restricted Recipient Support Coordinator (RRSC) role is designed to support the Restricted Recipient program (RRP). 



The position supports the program specialists by managing the incoming referrals for potential RRP members, triaging incoming calls from members and providers regarding the RRP program, completing administrative requests, and in completing all data entry for restriction information in multiple systems.  The position will also be responsible for maintenance and oversite of several operational reports and referral tracking. The RRSC Sr is accountable to provider the RRP manager report status updates as requested.



The RRSC’s also have direct contact with members who are enrolled in the RRP program, as well as clinical providers and pharmacies who provide care to these members.  RRSC’s may also outreach to providers or hospitals on behalf of the Restricted Recipient Program Manager or Medical Director.  The RRSC role needs a thorough and functioning understanding of the Restricted Recipient program and processes, as well as the Department of Human Services administrative rules regarding this program.


Accountabilities

1) Monitor and manage several operational reports to ensure the Restricted Recipient Program is carrying out all contractual requirements of enrollment and reenrollment in the Restricted Recipient Program including, but not limited to:




  • Maintaining end to end referral tracking to comply with DHS regulated time frames.

  • Creating and completing weekly reports (Dashboard report, Appeals report, etc.).

  • Assisting management with program oversight by reporting out data and statistics.



2) Prioritize RRP program referrals through system work queue management, mailbox management, daily activity reports, incoming telephonic referrals and any other method deemed necessary for member program enrollment.



3) Review referrals for completeness of information and attempt to resolve when appropriate (eligibility information, accurate phone number, etc.)  Ensure Restricted Recipient Program Specialists receive referrals or other information in a timely manner and according to established practices, workflow processes and departmental needs. Accurately apply specific guidelines, policies and procedures as authorized by medical management.



4) Completes all system documentation per process and regulatory standards within Medical Management, DHS, and external vendor systems. This role will be responsible for all restriction information data entry in accordance with DHS administrative rules and guidelines.



5) Triage all incoming calls from members and providers regarding RRP.  RRSC’s must be able to apply program rules to incoming exception requests and complete administrative exceptions per established Medical Management and DHS guidelines.  Complete outbound calls to providers and facilities per established guidelines or as directed by Restricted Recipient Program Specialists or the Medical Director.



6)  Recognize opportunities for improvement and initiate workflow changes in collaboration with leadership and staff. Create and update team job aids and processes for process improvement and to maintain consistency in workflow. Monitors the effects of process changes and provides quality feedback to Leadership.



7)Act as a resource to provide guidance and support to Support Coordinators. Actively participate as a member of a team and provide input to assure that quality standards and continuous quality improvement activities are met.



8) Lead special projects, as requested by Leadership, that require moderate to complex research, analysis and documentation skills. May assist manager with daily workload balancing and other work inventory assignment tasks.



9) Demonstrates proficiency with all functions of the Support Coordinator Role and serves as a subject matter expert (SME).


Requirements


  • High School diploma or equivalent.

  • 5 years customer service and /or related experience in medical management, health insurance or medical/behavioral health industry.

  • Excellent time management skills.

  • Demonstrated problem solving skills.

  • Ability to effectively apply and demonstrate workflow instructions and successfully meet turn-around-time expectations.

  • Strong systems and applications skills including data entry and MS Office Suite skills.  Demonstrated data entry skills and attention to detail and accuracy.

  •  Strong interpersonal and verbal skills—ability de-escalate members verbally and maintain excellent customer service skills.

  • Strong interpersonal and written communication skills; ability to express complex issues to individuals, groups, internal and external contacts, and write clear, concise and grammatically correct materials.

  • Demonstrated organizational skills and levels of productivity that meet/exceed established benchmarks.

  • Positive, professional, service oriented behavior.


Preferred Requirements


  • Associate degree in business or health related field.

  • Experience with Medicaid population and DHS MMIS system.

  • Working knowledge of BCBSMN products and systems strongly preferred.

  • Call center experience and training helpful for this position.


FLSA Status

Non-Exempt


Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association


Nearest Major Market: Minneapolis

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