The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
The Concierge Line Navigator is under the direction of the Manager, Concierge Line this individual is responsible for being responsive to member needs, questions, concerns and managing their resource needs. The position is also responsible for assisting members with choosing a PCP and or Specialist when requested, help manage the referral process including the transfer of medical records and when requested, assist in scheduling appointments to appropriate Care Coordinators based on patient need. The position requires excellent listening skills, the ability to research member and provider questions, and to provide timely follow-up ensuring that all questions or concerns have been fully addressed. The Concierge Line Navigator must at all times demonstrate a supportive demeanor while maintaining a positive, caring and professional attitude.
PRINCIPLE DUTIES AND RESPONSIBILITIES
Concierge Line Navigator is the customer service provider for payor-employer contracts; the liaison for plan members who connects them with other plan resources to ensure their needs and expectations are met.
Provides first line response for member and provider inquiries and requests including welcome calls to new product members, requests for services and referrals.
Completes data entry and information updates in ACN member database.
Verifies benefit eligibility and prior authorization, assists member in reviewing their benefit choice as necessary.
Assists members in finding a PCP or specialists including transition of medical records and schedules appointments as requested
Assists members in obtaining same day access to care when appropriate.
Makes post discharge Emergency Department outreach follow up calls as necessary.
Acts as a first line response for phone or electronic referrals for the Care Coordination team.
Receives incoming referral requests information, processes the referral and assigns patient to appropriate care coordination team or disease management program.
Provides disease management or other educational materials as requested.
Conducts necessary research for requests and identifies appropriate contact for transfer of calls.
Provides follow up with members to assure satisfaction with resolution to queries.
Sends outbound mailings including Welcome Packets, care coordination related letters and community resource information to members.
Completes all care coordination tasks assigned by ambulatory or transitional team members.
Customer Advocates for commercial insurance and employer self- insured programs.
Processes all transitions of care, out of network referral and complex issue resolution for plan programs to appropriate care coordination team member.
Run daily and weekly reports for clinical integration contract patients including error messages on Health Information Exchanges (HIE) as requested. Retrieve queries and save to patients charts through HIE.
May communicate information to members based on their preferred method of communication i.e., using secure massaging system, email or phone.
May assist member to gather their medical records through the HIE.
Ensure that any disclosures of the patient's referral information are compliant with HIPAA Privacy rule.
Assists practices to fill gaps in care and quality metrics by providing information when scheduling appointment for member.
Assists other ACN departments as needed.
Effectively works with patients, staff, health service providers, agencies, etc. from diverse backgrounds to reduce cultural and social-economic barriers between patients, institutions, and insurance.
May rotate staggered schedules of extended hours of 7:00 am to 6:00 pm weekdays and provide on-site coverage at employer campus(s).
Other duties as assigned.
- Minimum 1 year experience in a managed care and/or health care setting required.
- Medical terminology, Insurance authorization, insurance benefit knowledge, referral processing and authorization experience required.
- Back office medical assistant or scheduling experience helpful.
- Bi-lingual preferred.
- Excellent listening skills required.
- Demonstrated skills in the areas of verbal communication, judgment, critical thinking and problem-solving.
- Must be able to communicate clearly and concisely with all levels of individuals, sometimes in stressful
EDUCATION AND TRAINING:
High School Diploma or Equivalent required.
This position requires a highly motivated person with exceptional customer service, relationship management and interpersonal skills. Attention to detail. Capable of independent thinking, as well as perform in a team environment. Must maintain member confidentiality at all times.