Managed Care Representative in Altanta, Georgia | DiversityInc Careers

Managed Care Representative

DescriptionThe Managed Care Representative is responsible for providing high quality, client focused service by using (a) extensive knowledge of medical disease process and (b) extensive knowledge of state and federal program requirements to assist Medicaid beneficiaries in the application process for Federal program benefits such as Supplemental Security Income (SSI) or Medicare. The position works directly with individuals by phone.

• Interview Medicaid beneficiaries by telephone to determine eligibility for Federal disability benefits.
• Make a determination of potential eligibility based upon the medical definition of disability as it relates to body systems, functions of daily living and medical record information.
• Complete applications for Federal programs, reviewing medical records and taking all necessary action to expedite benefit approval.
• Provide assistance to applicants who encounter problems during the application process.
• Adhere to company and legal standards regarding Protected Health Information (PHI) and Personal Identifiable Information (PII).
• Maintain ongoing communication with government agencies regarding the status of applications as needed.
• Maintain detailed documentation of client contacts and application status in Change Healthcare computer systems and web-based applications.
• Provide updates and assistance to management and Change Healthcare staff as needed.

Education / Training:

• Associate or Bachelor degree

Business Experience:

• One to two years of call center experience.
• Benefits enrollment experience; preferably Disability Determination Services within the Social Security Administration, Managed Care Organization, Department Family & Children Services; or financial counseling experience.

• Bilingual Preferred
• Strong communication skills with a wide variety of audiences
• Excellent customer service skills