Restricted Recipient Support Coordinator

BCBSM, Inc.; Eagan (MN); Remote; USD 30,000 - 37,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Life insurance

401k

PTO

Volunteer Paid Time Off (VPTO)

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a Restricted Recipient Support Coordinator to manage referrals for potential members, triage calls from members and providers, and perform data entry across multiple systems.

The role is telework-friendly with preference for Minnesota residents and involves contact with members, clinicians, and pharmacies, plus outreach to providers when needed.

Qualifications

• 4+ years in related role or 2+ years internal experience.
• High school diploma or equivalent.

Responsibilities

• Complete system documentation per process and regulatory standards.
• Triage incoming calls from members and providers regarding RRP.
• Apply program rules to requests and complete administrative exceptions.
• Perform data entry for restriction information across DHS and Medical Management systems.

Skills

Experience with care coordination

Communication skills

Education

High school diploma or equivalent

Job description

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll Have

The Restricted Recipient Support Coordinator (RRSC) role is designed to support the Restricted Recipient Program Specialist and the Restricted Recipient program (RRP). In this position, you will support the program specialists by managing the incoming referrals for potential RRP members, triaging incoming calls from members and providers regarding the RRP program, completing administrative requests, and in completing all data entry for restriction information in multiple systems. You will also have direct contact with members who are enrolled in the RRP program, as well as clinical providers and pharmacies who provide care to these members. You may also outreach to providers or hospitals on behalf of the Restricted Recipient Program Manager or Medical Director. While this role is fully remote, we welcome all qualified applicants; however, preference will be given to candidates currently located in Minnesota.

What You'll Do

• Prioritize RRP program referrals through system work queue management, mailbox management, daily activity reports, incoming telephonic referrals and any other method deemed necessary for member program enrollment.
• Review referrals for completeness of information and attempt to resolve when appropriate (eligibility information, accurate phone number, etc.).
• Ensure Restricted Recipient Program Specialists receive referrals or other information in a timely manner and according to established practices, workflow processes and departmental needs.
• Accurately apply specific guidelines, policies and procedures as authorized by medical management.

How You'll Do It

• Completes all system documentation per process and regulatory standards within Medical Management, DHS, and external vendor systems.
• This role will be responsible for all restriction information data entry in accordance with DHS administrative rules and guidelines.
• Triage all incoming calls from members and providers regarding RRP.
• RRSC's must be able to apply program rules to incoming exception requests and complete administrative exceptions per established Medical Management and DHS guidelines.
• Complete outbound calls to providers and facilities per established guidelines or as directed by Restricted Recipient Program Specialists or the Medical Director.
• Recognize opportunities for improvement and initiate workflow changes in collaboration with leadership and staff.
• Demonstrate the ability to modify approach based on customer demands.
• Actively participate as a member of a team and provide input to assure that quality standards and continuous quality improvement activities are met.
• Accept accountability for more complex assignments and special projects that require moderate to complex research, analysis and documentation skills.
• May assist manager with daily workload balancing and other work inventory assignment tasks.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 4+ years of experience in related role or 2+ years internal experience.
• High school diploma (or equivalent).

Preferred Skills & Experience

• Ability to communicate detailed information to diverse audiences, actively listen to understand varied perspectives, and facilitate alignment on operational priorities.
• Ability to analyze complex operational issues, evaluate tradeoffs, and collaborate with stakeholders to reach effective, sustainable solutions.
• Ability to organize work across multiple assignments, balance shifting priorities, and manage time to meet commitments while supporting team coordination.
• Healthcare experience and/or knowledge of the managed care and health care/insurance industry.
• Experience with healthcare regulations including Mental Health Parity (MHPAEAA) Federal Regulatory requirements and applicable state laws.
• Medicaid and commercial insurance experience.
• Understanding of population health management trends, clinical program design, and healthcare market dynamics.
• Experience developing and implementing strategy and strategic initiatives.
• Process improvement and ability to implement tools or systems that improve team efficiency and accuracy.
• Understanding of medical claims and coding.

Role Designation

Teleworker Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.

Compensation and Benefits

$21.64 - $27.05 - $32.46 Hourly Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Aff… All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [e-mail]. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association. Physical requirements. Chartered in 1933 as Minnesota’s first health plan, this company is one of the most recognized and trusted healthcare brands in the world.