Job description
This is a multifaceted position responsible for authorizations, service delivery and provider inquiries for the CHOICES and Employment & Community First (ECF) CHOICES Programs. The LTSS Specialist I will work in partnership with Care Coordinators and Support Coordinators to promote interdependent collaboration with the member, physician/primary care manager, family, and other members of the Care and Support Coordination Teams, including outreach to members to ensure continuity of care.
Job Description:
BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.
Job Responsibilities
- Ensure compliance with contractual obligations and government regulations are sustained to avoid penalties.
- Review and complete reports as directed by management.
- Analyze and make comparisons on person center support plan for members and issues.
- Manage services on person center support plan for members, issue and verify authorizations for services, and collaborate with Care Coordinators/Support Coordinators to ensure accurate service provision.
Job Qualifications
Education
- High School Diploma or equivalent
Experience
- 2 years - Experience in claims or customer service required
Skills\Certifications
- Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
- Capacity to solve problems and manage multiple assignments with critical deadlines
- Effective time management skills
- Excellent oral and written communication skills
- Strong interpersonal and organizational skills
- Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic
Job Specific Requirements:
Preferred Qualifications:
-
Prior medical background is highly preferred.
***Please note: This position requires a flexible schedule within the operating hours of 7:30 AM EST/6:30 AM CST to 6:00 PM EST/5:00 PM CST.***
Preferred Skills:
Number of Openings Available:
1
Worker Type:
Employee
Worker Sub-Type:
Employee
Company:
VSHP Volunteer State Health Plan, Inc
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
All applicants will be advised that BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
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