Case Specialist Hcms resume example

Provide members with information on how to access preventive and health maintenance services while identifying barriers to care.

Arrange transportation for members as needed if applicable

Conduct telephonic and or home visit education with members.

Collect members encounter data and medical records.

Review medical records for completeness.

Promote and distribute educational materials and program information to members.

Assists members in making follow-up appointments with there pcp.

Provide telephone follow-up to ensure members have seen their pcp for preventive care.

Promotes and supports the pcp relationship

Refers issues and concerns about to members to the case manager or member advocate.

Serve as a referral agent to internal services & external also.

Educate members and providers about plan policies and services when contacts are needed.

Assists members in identifying community resources for the management of their disease as directed by the case manager

Assists members in obtaining appropriate health education materials, classes and programs for the required level of care.

Documents member participation of member outreach activities.

Records and reports all members outreach activity.

Telephonic assistance to Members and Providers.

Functions as a referral source for Members and Providers.

Ability to explain the health benefits available to membership in the various markets.

Able to assess member's referral needs and give appropriate network referrals.

Coordination, authorization, fulfillment, monitoring, and tracking of health care services.

Knowledge of care-coordination and case management concepts.

Utilizes knowledge of community resources.

Refers members to case management or care management as indicated.

Ensures that health care services are received as authorized by the provider.

Maintains accuracy for compliance with departmental standards and policies.

Interacts with provider community and various departments to resolve issues involving the membership.

Arranges for services as identified by the Care Manager or the Case Manager.

Maintains Member confidentiality.

Collaboratively works with other departments.

Utilizes excellent customer service principles to assist internal and external customers.

Adheres to all company policies concerning the preauthorization process.

Adheres to all state, accreditation standards and regulatory guidelines

Follows HIPAA guidelines, Call Center quality performance standards and guidelines for Aux work usage.

Documents all pre-certification and authorization required.

Handle inbound calls from existing customer, where I placed orders for goods and services.

Worked daily on incoming orders via-faxes for processing

Input all orders through a data entry processing.

Issued and maintain daily production reports

Provided customers with status of all ship goods.

Assist new and existing customers in the selection and purchase of products and services.

Effectively communicate product and service information, feature functionality, billing procedures and equipment usage to each customer.

Productively follow-up with customer after the sale to guarantee product and customer satisfaction.

Process customer bill payments.

Effectively answer basic customer service questions and make outbound calls for customer follow -up and prospecting opportunities.

Effectively perform other office duties including accessory stock, update/request inventory.

Provide high levels of customer service and interact positively with customers to offer sales solutions for communication needs to include product/service upgrades.

Work independently to meet successful target outcome per monthly sales quota.

Reconcile/balance cash registers.

Exercise good decision-making skills. While providing flexible work hours