PAC Case Administrator at CareCore National, LLC in FRANKLIN, Tennessee

Job Description:

Summary

The PAC Case Administrator responsibilities include but not limited to:

• Maintain workflow activities for the PAC Health plan product for inbound and outbound communications between eviCore Healthcare stakeholders and external hospitals, physicians and Post-Acute Care providers.


• Demonstrate complete understanding of how to research and resolve issues pertaining to the pre-certification process and day-to-day operational concerns using defined processes.


• Demonstrate full understanding and ability to differentiate the Post-Acute Care processes over multiple health plans across multiple states to ensure compliance with both Medicare and Medicaid guidelines by state regulations.


• Communicate all state specific and national health care laws to external hospitals, physicians and Post-Acute Care providers including the appeals/reconsideration policies.


• Inbound and outbound communications tasks include coordination of inbound requests from hospitals, physicians and Post-Acute Care providers for pre and re-certification, status checks on existing cases, directing calls to internal departments, notification calls to hospitals and Post-Acute Care providers regarding incomplete pre-certification requests, as well as authorization approvals.


• Receive faxed information via internal and external systems from hospitals, physicians and Post-Acute Care providers, completing the activity for the request including case creation for pre-certification, attaching to an existing case for re-certification, and assigning to the appropriate staff for case closure.


• Evaluate client trends to report and partner with the appropriate internal stakeholders in order to address and resolve through facilitation of communication between clients, providers, IT and other eviCore healthcare team members.


• Position is part of a call center and will require working phone for the majority of the shift.


• Required to complete pre-employment skill test for typing and computer literacy.

What You Should Have

Education:

• High School graduate with diploma or equivalent. Associates or Bachelor's degree preferred.

Experience:

• 2+ year of experience in healthcare contact center or customer service preferred.


• Medical background with Post-Acute Care experience preferred.


• Experience with insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid preferred.


• Various schedules to cover operating hours (7AM - 8PM CST).


• Maintain flexibility to variations in work volume/work schedule, which sometimes require extended working hours.


• Position may require rotating weekend and holiday coverage. Certain postings may require regular weekend coverage based on business and client needs.


• Currently position is remote but position location is subject to change.


• Provides excellent customer service to clients and providers by ensuring there is full understanding of the resolution or action plan.


• Ability to navigate multiple platforms that contain provider data, member information, and authorizations.


• Daily focus on attaining productivity standards, recommending new approaches for enhancing performance and productivity when appropriate.


• Time-management: Ability to effectively manage one's time and resources to ensure that work is completed efficiently. Excellent organizational skills.


• Communication: Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership.


• Critical-Thinking/Decision-making: Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities.


• Autonomy: Ability to work independently with little to no supervision.


• Ability to complete special projects or other duties as assigned.


• Proficient with various applications or software, such as: Microsoft Outlook, Word, Excel, and PowerPoint and demonstrate ability to utilize all resources to support the manual functionality of the PAC system.

Our Company and What We Offer

eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits to our Non-Clinical Intake Representatives, including, but not limited to:

• Full medical, dental, vision, and vision benefits with employer funded HSA starting day 1*


• Strong work/life balance with work from home opportunities based on performance


• 15 days of PTO (starting) per year plus paid holidays


• Ample opportunities for professional growth and promotion including career pathing for clear expectations of advancement within the company and education assistance


• A monthly pay for performance bonus incentive


• Time away from work programs including employer paid short-term and long-term disability, caregiver leave, BTO (bought-time off) options, company paid volunteer community service hours, and more


• Onsite fitness facilities, casual dress code- wear your jeans to work, and two comprehensive employee discount programs


• Health coaching, Employee Assistance Program, resiliency and stress management solutions, Adoption Assistance Program and additional resources to support your well-being


• Life & Accidental Death Dismemberment and additional Accidental Injury, Critical Illness, and Hospital Care Insurance


• 401k retirement plan with company match of 50% employee contributions up to 6%

And so much more! Check out evicore.com/careers to see all of the perks and benefits we offer.

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