Special Need Plan Program Technician

Special Need Plan Program TechnicianRegularNon-ExemptGENERAL DESCRIPTION:Responsible for receiving, registering, and forwarding applications received within the unit to certify the chronic conditions of beneficiaries for a chronic product. Responsible for the confirmation of chronic conditions for the C-SNP plan members. Enters data from health status and risk factor assessments (Self-Assessment) received from beneficiaries and/or authorized representatives on the electronic platform.ESSENTIAL FUNCTIONS:•On the first business day of each month, receives population to be impacted under the C-SNP Confirmation Process, which must be addressed on or before the first ten business days per applicable policy and procedure.•Contact physicians to obtain confirmation that the enrollee has a condition that qualifies for the Chronic Condition Special Needs Plan (C-SNP) after enrollment.•Completes the C-SNP confirmation process (attempts, documentation, and evaluation) in the electronic file in TruCare by policies and procedures, which include:o Faxes or emails correct the Chronic Condition Confirmation Form as requested by providers.o Maintains assigned reports and reports to supervisor as requested.o Refers to members for whom chronic conditions could not be confirmed to the provider areas.•Maintains constant communication with the Enrollment Department and immediately alerts them to situations that may adversely impact member eligibility for the chronic product.•Refers to members for whom chronic conditions could not be confirmed to the provider areas.•Supports clinical staff interventions, including but not limited to, appointment member coordination, provider referrals, sending educational materials to members, etc., whenever necessary.•Contact members by telephone to obtain updated provider information whenever necessary.•Identifies deficiencies and/or patterns and shares them promptly with the immediate supervisor.•Meets established productivity, quality, and timeliness metrics as applicable regulations require.•Data entry of health status assessments and risk factors (Self-Assessment) received from beneficiaries.•Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.•May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.MINIMUM QUALIFICATIONS:Education and Experience: An associate's degree in Business Administration, or related areas, or at least sixty to sixty-four (60-64) approved university credits equivalent to two (2) years of studies. At least one (1) year of previous experience in healthcare settings, particularly in clinical or administrative roles, is preferred."Proven experience may be replaced by previously established requirements."Certifications / Licenses: N/AOther: N/ALanguages:Spanish – Advanced (comprehensive, writing and verbal)English – Advanced (comprehensive, writing and verbal)"We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities."