Steward Health Care System
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at Steward Health Care System
Position Purpose: Provide support to the Health Choice Member/Outreach Department by performing various clerical functions and maintained organized and effective procedures to support the department (including but not limited to):
- Adhere to HIPAA laws at all times; notify Privacy Officer immediately upon learning of a real or potential breach of protected health information.
- Process eligibility updated/ PCP changes / Open Panel Requests (MS, Providers, finance, IT, Network)
- Work with IT to ensure eligibility is transmitting correctly to our vendors (Optum, MTBA, Clarity, etc.)
- Interface with outside agencies to report or verify eligibility and update as necessary (UDOH, CMS, PMMIS, AHCCCS on line and Optum)
- Prioritize work flow to maintain an efficient process of completing the assignments daily
- Various error reporting (Pharmacy Report, Encounter Report, Daily Report, Finance Report, etc.)
- Maintain Eligibility Mailbox (Processing incoming request, respond to inquiries from other departments, Materials Request, Claims History Request, etc.)
- HIPAA / Discharges
- Serve as back-up for Member Services Representative as necessary
- Serve as back-up for Retention outbound projects as necessary
Education / Experience / Other Requirements
Years of Experience: