Key Facts

Remote From:

Oregon (USA) , South Carolina (USA)

Category: Medical Administrator

Full time

English, Spanish

Hard Skills

Internal Documentation Medical Surgical Nursing Electronic Referrals Telephony

Other Skills

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Customer Service
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Organizational Skills
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Quality Assurance
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Time Management
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Teamwork
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Communication

Roles & Responsibilities

medical assistant experience
case management experience
medical claims assistant experience
bilingual English/Spanish preferred

Requirements:

Responds to phone inquiries from providers, patients, case managers, peer reviewers and directs to the appropriate handling party
Make initial contact for case management staff and with providers to obtain clinical information
Assist with case management workflow and documentation, preparing routine correspondence for Case Managers, physicians, and patients
Identify caller/patient needs and determine appropriate actions including clinic referrals or escalation processes

TRISTAR Insurance Group

Insurance

About TRISTAR Insurance Group

TRISTAR began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR. We are the largest privately held third party claims administrator in United States. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services. We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically. At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity. At TRISTAR, you help create a world in which together we "transform risk into opportunity".

Company type: SME

Industry: Insurance

Founded: 2018

Company size: 501 - 1000

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Job description

This is a remote position. Preference is remote in Texas.

**Preferred experience: medical assistant; case management experience necessary; medical claims assistant.

**Bilingual English/Spanish preferred.

POSITION SUMMARY:

Work directly with the Supervisor and Manager to provide additional resources to the case management staff. This position does not provide any clinical review or decisions.

This individual is responsible to ensure the referrals are set up in the Utilization Review/Case Management system and promptly assign to the case manager. The Case Management Assistant will answer incoming calls, screen, respond and route the calls. This position requires the ability to work independently to meet deadlines, as well as an excellent phone demeanor and a desire to provide exceptional customer service. The position requires knowledge of medical terminology, the understanding of referral criteria by client and/or jurisdictions.

ESSENTIAL DUTIES AND RESPONSIBILITIES RESPONSIBILITES:

Responds to phone inquiries from providers, patients, case managers, peer

reviewers and directs to the appropriate handling party

Make initial contact for case management staff
Initial contact with providers to obtain clinical information

Assist with case management work flow and documentation prepares routine correspondence for Case Managers, physicians, and patients
Identify each caller/patient’s needs and determine the next appropriate action, which may include clinic referral or identifying the necessity for the escalation process to be activated.
Communicates effectively with all parties, such as case managers, physicians, claims team, and ancillary providers and/or vendors/agencies to ensure that patient information is current, accurate, and complete
Prints and mails correspondence to all necessary parties in accordance with state

rules and regulations

Other duties as necessary assigned by supervisor

Responsibilities of the position include, but are not limited to:

Assist incoming calls to the case management department
Monitor dedicated queues/emails

Process all determinations and correspondence within 24 hours of receipt
Actively participate as a member of the team, working collaboratively with and supporting other staff.
Complete the assigned deliverable/billable hours per week, as assigned by your Supervisor.
Identify trends and/or issues in referral patterns and communicate them with management.

***Other duties as assigned

Additional Functions and Responsibilities

Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
Maintain documentation standards adhering to URAC standards and company policy and procedures
Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
Other job duties as assigned