Job Description

:Our home health and hospice agencies are located throughout California, Hawaii, Oregon and Washington. They serve the entire community and offer personalized in-home care, and many have been recipients of Home Care Elite awards.So whether you\'re looking for the buzz of a large city, the tranquility of nearby mountain bike trails or something in between, we encourage you to explore our organization.Job Summary:Provides day-to-day support for the Home Health patients and department. Assists in coaching, mentoring and providing on-going feedback to Customer Care team members.Job Requirements:Education and Work Experience:

• High School Education/GED or equivalent: Preferred
• Associate\'s/Technical Degree or equivalent combination of education/related experience: Preferred
• Five years\' relevant experience: Preferred

Essential Functions:

• Handles incoming calls from plan members and healthcare providers for the assigned health plans. Provides information as needed for questions related to medical, dental, vision, and prescription drug claims based upon the benefit descriptions and plan provisions of a variety of group plans. Documents all calls.
• Receives referrals and pre-certification requests from providers as applicable. Reviews referral/pre-certifications for proper benefits and eligibility. Enters referrals and pre-certifications data into the computer system. Reviews referrals and medical record information as applicable to facilitate claims department with claims adjudication. Researches and documents rejected or erroneous claims and forwards them for correction as needed.
• Assist in interviewing and training new Customer Service Representative (CSR) team members and provide input into performance evaluations of CSR team members. Assist in coaching, mentoring & providing on-going feedback to CSR team members.
• Performs other job-related duties as assigned.

Organizational Requirements:Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

Adventist Health