Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:

Job Summary:

The primary role of the Clinical Support Services (CSS) Coordinator is to process clinical prior authorization requests and respond to provider inquiries as it is relates to processed or requested prior authorizations. CSS Coordinator will work with clinicians, service providers and other internal departments to ensure notification to approved medical services is obtained under plan benefit. CSS Coordinator must follow plan guidelines and meet required turnaround times. Will be responsible for a varied workload and provide administrative support in the most efficient, accurate, and professional manner possible. Position requires the use of judgment and initiative to determine approach or action for necessary non-routine situations.

• Review and distribute incoming RAN’s according to department processes.
• Respond to provider inquiries
• Verify appropriate information is completed on request form (RAN)
• Confirm member eligibility
• Contact Provider’s office to gather additional member information (if applicable)
• Create prior authorizations for requested services and assign authorization to appropriate staff according to plan guidelines
• Document in the Authorization Information System any update(s) or change(s) requested by providers on existing authorizations
• Ability to interpret and document basic medical terminology, ICD10 codes
• Ability to organize, prioritize, multi-task, communicate and manage workload effectively and efficiently
• Communicate professionally with external and internal consumers regarding prior authorizations.
• Assist with preparation, tracking and maintenance of reports necessary to carry out the functions of the department
• Communicate regularly with other employees, managers and other designated contacts within the organization
• Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment. Able to accept direction.
• Perform other duties and responsibilities, as assigned
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Required Competencies & Qualifications:

• High School Diploma or Equivalent
• 1-3 years experience in healthcare administrative support, customer service or equivalent.
• Strong verbal and written communication in English.
• Strong organizational skills
• Operation of general office equipment to include PC, fax/copy machine and ACD Mitel Phones.
• Advanced skills using Microsoft Office Programs (Word, Excel, Outlook and PowerPoint).
• Strong critical thinking skillsAble to work independently in an online remote environment.

Physical Demands/Working Conditions:

• Inside working conditions.
• No environmental hazards.
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Salary Range: $16.50 - $19.00 an hour

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record), disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.