Cost Management Associate

Colonial Group; Melbourne (FL); Presencial; USD 40.000 - 50.000; Jornada completa

Descripción de la vacante

Christian Care Ministry's Medi-Share seeks a Customer Care Specialist to support the Cost Management team by managing a large caseload, including medical records collection, refunds, and form uploads.

You will communicate with members and providers via phone, email, and fax, and document case notes in Salesforce or CSI while upholding Christian-based service values.

Formación

• High school diploma or GED.
• 1-2 years administrative and/or phone-based customer service experience.
• Healthcare payer or healthcare organization experience preferred.

Responsabilidades

• Assist members as primary contact with providers to obtain medical records and authorizations.
• Obtain refunds by working with providers and handling documentation.
• Document receipt of requests and authorizations in required systems (Salesforce, CSI).
• Open and route cases; update case notes in required systems.
• Review reports and queues; escalate high-risk or high-dollar cases to leadership.

Conocimientos

Critical thinking

Communication

Reading comprehension

Math

Computer skills

Time management

Thoroughness

Educación

High school diploma

Herramientas

Salesforce

CSI

Microsoft Office

Excel

Teams

Outlook

Descripción del empleo

Summary

Medi-Share differs from traditional health insurance with its sharing model, faith-based values, and affordability. The Cost Management team aims to improve the Medi-Share program's sustainability by conducting cost steerage efforts resulting in over $90 million saved annually.

In this position, the Customer Care Specialist supports the Cost Management team by managing a large caseload of various tasks including collection of medical records, facilitating refunds, uploading forms and files, and communicating with Medi-Share members and medical providers through phone calls, emails, and faxes.

Essential Duties and Responsibilities

• Support members as primary point of contact with providers in obtaining required medical records – including providing and receiving written and telephone communication
• Serve as primary point of contact with members in obtaining authorizations
• Confirm and appropriately document receipt of medical record requests and authorizations by providers
• Work directly with providers to obtain refunds on inaccurately shared bills
• Effectively communicate guidelines to providers to retrieve necessary information and guide parties through established processes/procedures
• Forward, send, and/or label incoming documentation (i.e. forms, authorizations, legal, etc.) when applicable – providing accurate and detailed case notes in required systems
• Handle multiple cases and document appropriate notes & status in required billing system (i.e. SalesForce, CSI)

• Review reports to determine and open cases that need to be worked by other internal team members
• Assess cases within queues, sending them to appropriate areas to work/review
• Keep leadership informed of high risk/high dollar cases
• Offer to pray with providers and members on every call

• Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs

• All other duties as assigned

Essential Skills & Abilities

• Critical Thinking & Problem Solving:Ability to diagnose complex problems and issues providing multiple, viable solutions.
• Interpersonal & Communication Skills:Ability to effectively communicate in verbal and written form. Ability to align all communication with the mission, purpose, and values of CCM. Must be able to foster good relationships with co-workers and speak effectively with providers and fellow associates.
• Reading Comprehension:Ability to read and interpret documents such as medical records, operating and maintenance instructions, and procedure manuals.
• Mathematical Skills:Ability to add, subtract, multiply, and divide into all units of measure, using whole numbers, common fractions, and decimals. Ability to compute percent and to interpret bar graphs.
• Computer Skills: Ability to use the internet, including e-mail and search engines, word processing and keyboard skills of at least 25 words per minute, ability to use a database system including how to update fields and basic knowledge of Microsoft Office (Excel, Teams, Word, and Outlook).
• Time Management Skills: Possesses a strong sense of prioritization and able to organize the day accordingly.
• Thoroughness: Ensures information is complete, accurate, and follows the guidelines put in place for each task.

Core Competencies/Demonstrable Behaviors

• Collaborates: Builds partnerships and works collaboratively with others to meet objectives. This role requires a high level of internal and external customer interaction to meet objectives.
• Nimble Learning: Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.
• Drives Results: Consistently achieve results, even under tough circumstances and tight deadlines.
• Member First: exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program’s purpose. This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction. Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences.
• Humble: demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition
• Hungry: exhibits initiative, perseverance, and commitment to serving God through excellence. Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry
• Smart: shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment

Education and/or Experience

• High school diploma/GED required
• 1-2 years administrative and/or phone-based customer service experience required
• Relevant experience in a healthcare payer or healthcare organization preferred

Supervisory Responsibilities

This job has no supervisory responsibilities