About Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
*This position is remote, however preference will be given to Minnesota residents*
The Health Support Coordinator (HSC) is a member of the Blue Cross Blue Shield of Minnesota (BCBSMN) Care Management (CM) team and is responsible for cross-functional support within the CM department. In this role, the Health Support Coordinator provides moderate to advanced support to CM clinicians with their utilization management, case management, and disease management activities, with the processes currently in place for medical, surgical, and behavioral health. This position will interact with members, providers and other stakeholders .A major responsibility will be to provide customer service to both internal and external customers by telephonic or through written inquiries which typically involve reviewing prior authorizations, admission notifications, concurrent and post-service (pended claim) review requests, program referrals, work queue management, and benefit/eligibility for case management, disease management, and utilization management requests/programs. Work involves learning and assisting with the implementation of new workflow processes, prioritizing and providing referrals to health coaches for member outreach, and providing initial non-clinical triage functions for requests within Care Management.
Receive, research, prioritize and respond to Utilization Management, Case Management, Disease Management (UM/CM/DM) requests and program referrals through mailbox management, system work queue management, incoming telephonic and written pre-service, post-service (pended claim), and concurrent care requests.
Outbound calls to providers and facilities as warranted.
Receive and route inbound calls from members, providers, customer service, or other internal stakeholders per process.
Maintain an outstanding level of customer service throughout all points of customer contact.
Ensure the appropriate clinical staff receives the call, or written request in a timely manner and according to established practices, workflow processes, and departmental needs.
Accurately apply specific guidelines, policies, and procedures as authorized by the clinical review areas and in coordination with UM/CM/DM activities.
Research appropriate systems for medical record information and/or pended claims history and prepare medical record information and/or claim to be processed, if appropriate, or set up and assign to clinical review staff.
Check daily activity reports and adjust work priorities accordingly.
Establish and maintain relationships with both internal and external customers.
Provided regular back-up assistance to other team members.
Accept accountability for special projects, assignments or reports that are more difficult in nature and require moderate to complex research, analysis, and documentation skills.
Recognize opportunities for workflow process improvement and initiate workflow changes with leadership.
Cross-trained with demonstrated accuracy in multiple intake and support functions.
2+ years of related experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Excellent data entry skills and attention to detail and accuracy.
Demonstrated time management skills.
Abilities to effectively apply and demonstrate workflow instructions and successfully meet turn-around-time expectations.
Good MS Office Suite skills.
Knowledge of mainframe, web-based applications, and populating data in to MS Access databases and other systems/applications.
Strong interpersonal and verbal and written communication skills; ability to express moderate to complex issues to individuals, groups, internal and external contacts, and write clear, concise and grammatically correct materials.
Strong organizational, research, and analytical skills.
Demonstrate decision making and problem solving skills.
Demonstrate the ability to effectively deal with escalated situations.
Positive, professional, service oriented behavior.
Bachelors or Associate degree.
Current call center environment training and experience.
Working knowledge of BCBSMN products and systems strongly preferred.
BCBSMN Provider or Customer Service experience.
Medicare and Medicaid knowledge.
Claims process experience.
Make A Difference 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, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
