Nurse Case Manager-Telecommuting

Department:  AmeriBen Compass Medical Mgmt
Supervisor: Compass Supervisor
Shift:  Exempt
Pay Range: $47,756-$58,491

A Nurse Case Manager will, in accordance with the Nursing Process, the Standards of Nursing Practice, and URAC regulations, facilitate the appropriate health care services in the most cost effective manner to promote an optimal outcome without compromising quality of care.  An additional benefit to this position is the ability to telecommute after the 90 day introductory period if eligibility requirements have been met. 

Key Result Areas:  

  • Establish personal contact with patients and family members
  • Assess the patient's current status, prognosis, future care needs, treatment plan and alternative treatment plans
  • Assess the family dynamics and home environment and needs
  • Identify barriers to recovery
  • Adhere to all URAC standards
  • Develop and implement individualized Case Management plans
  • Evaluate effectiveness of care plan and progress made by patient
  • Document findings and appropriate cost effective recommendations within identified timelines using URAC regulations
  • Capture and record any  cost savings
  • Act as a liaison between referral source, family, employee, physician, facilities and providers, employer and internal and external stop loss
  • Maintain confidentiality of records and information
  • Maintain and report applicable statistics regarding programs and patient services  

Minimum Qualifications:  

  • Current Idaho R. N. license and CCM certification or 2 years Case Management experience and eligible to sit for the CCM certification exam
  • Diverse clinical experience
  • Knowledge of HIPAA and DOL regulations
  • Strong interpersonal relationship skills and the ability to work effectively with a diverse patient population.
  • Ability to communicate effectively, both orally and in writing, medical information to health care professionals, employer groups, Brokers, stop loss personnel, internal customers, members and patient families
  • Ability to work independently
  • Time management, Organizational, Research, Analytical, and Records Maintenance skills
  • Negotiation skills
  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines \
  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self
      

Customer Care Representative I

Department: Customer Care Services                           
Supervisor: Cust. Care Sr, Lead
Shift:  Monday - Friday, 7am-6pm
Shift: 8 Hour May Vary                               
Posting Expires: 3/9/10
Pay Range: $11.45 - $13.45                                          
 
 
As a Customer Care Representative, you answer or direct incoming calls and respond to customer inquiries regarding claims benefits which will involve researching and resolving problems for customers. 

Key Result Areas:

  • Answers incoming telephone calls
  • Responds to claims questions from customers regarding benefits, eligibility and coverage. Explains policies to customers
  • Researches customer inquiries, completes the follow-up and paper work
  • Research calls returned within 48 hour turnaround time or as promised
  • Must meet 5 day turnaround time with Call Tracking
  • Must take an average of 60 calls per day after training has been completed

Minimum Qualifications:

  • High school education or equivalent
  • Minimum one year of customer service experience
  • Knowledge of medical and dental terminology a plus
  • Excellent customer service attitude and professionalism
  • Team and goal oriented
  • Exceptional interpersonal and problem solving skills
  • Good organizational, written and verbal communication skills
  • Types 45 wpm, 10-key and computer knowledge
  • Good knowledge of Microsoft Office software (Word, Excel, Power Point, and Outlook)
  • Ability to organize, work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines
  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self
     

Client Accounting Clerk II 

Department: Client Accounting                       
Supervisor: Client Accounting Supervisor
Posting Expires: 3/16/10
Pay Range: $11.45 - $15.46 

Handles accounting for and resolve of Voids and Reimbursements.  Researches and resolves Call Tracking inquires on checks.  Processes Client deposits and reporting. Monitors and approves Bank exceptions.  Records COBRA checks and Premium Holding deposits in system.  Assists with monthly Credit Intec audit. Oversees the dept files and storage retention records.

Key Result Areas

Essential

  • Responsible for accurate tracking all provider voids and reimbursements received, coordinating with Claims dept to properly and timely credit adjustments in the GBAS Accounting system.
  • Reviews and records COBRA & Retiree premiums in CFUND.
  • Researches check status, determines Stop Pays on client accounts and coordinates with Claims Dept when reissue is required.  
  • Monitors bank accounts on-line for Exceptions, and determines validity of check for payment. 
  • Works closely with Banks obtaining bank statements and other banking information.
  • Processes Premium Holding deposits and records monthly deposits transactions in CFUND.  M
  • Monitors, researches and resolves Call Tracking for department within standard turnaround time.
  • Report administration fees for quarterly PG penalty reporting.
  • Assists Accountant with monthly Credit Intec audit to ensure complete and accurate record of claims adjustments. 
  • Perform Unclaimed Property research as needed and report final unclaimed property to Client's for their reporting to the State. 
  • Oversees the record retention of Client Accounting files.

Additional

  • Performs special duties as assigned by Supervisor.
  • Provides backup support for Clerk I and Accountant I positions in the department. 

Minimum Qualifications

  • High school graduate or equivalent. 
  • Two - three years minimum experience in accounting, bookkeeping and / or banking related functions.
  • Strong attention to detail, accuracy with numbers and checks, very proficient 10 key and data entry skills.
  • A flexible team player who possesses integrity, takes initiative and uses good judgment.
  • Intermediate level knowledge of Excel, proficient in Word, Internet and good computer skills.
  • Good analytical and problem solving skills and works well in multi-tasking environment
  • Ability to prioritize tasks, perform multi-functions, meet tight deadlines with a high volume workload.
  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable ommodation without posing a direct safety threat to others or self

Typical Minimum Standards

  • Adherence to the values and mission of AmeriBen / IEC
  • Work as a team with corporate employees and all internal & external customers
  • Complete all projects in a timely and accurate manner