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 – Position Summary

The Operations Specialist - Health Coordination is responsible for the overall data integrity of member electronic records in Health Coordination. Ensures caseload accuracy, program status, and Health Coordinator assignment on daily basis. Researches and provides information to claims and health coordination management regarding LTSS and HCBS Utilization. Assists in health coordination staff training. Develops and analyzes operational reports, follows up on staff inquiries, and completes research on quarterly organizational reports. Conducts one-time or periodic special projects.

Primary Duties & Responsibilities:

• Updates member electronic records daily through assignment, reassignment and un-assignment activities. Conducts quality assurance activities and seeks clarification from Service Coordination staff and management as appropriate.
• Completes Long Term Service and Support (LTSS) member enrollments. Researches LTSS placements, cost share and assigns accordingly. Updates LTSS record as documents are submitted to Service Coordination Director.

• Researches LTSS and HCBS claims for accuracy of services and authorizations.
• Assists in HCBS processes and tracking services, such as electric bill reimbursement
• Provide technical training to health coordinators on system operations
• Processes member referrals and assists with triage and caseload balancing
• Disseminates monthly caseload report and LTSS Assessment and Reassessment reminders to staff.
• Conducts 1147/1148 reconciliation, cost share, CCMA/CCFFH outreach and Transition of Care files.
• Assists in the coordination and organization of activities and meetings by collaborating with internal and external resources.
• Assists with internal and external health coordination reports and Key Initiatives.
• Assists in the development of routine reports, track and trend Health Coordination performance, effect and facilitate ongoing performance monitoring of program(s). Provides data and analytical support for department initiatives.
• Assists with standardized and automated report development with Health Coordination Managers and Data Analyst team.
• Perform other duties 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 Qualifications:

• Associates Degree
• 2 to 3 years of related work experience.
• Previous experience performing data analysis, conducting research and data collection.
• Must be capable of working under tight deadlines, with the flexibility to work on several projects concurrently.
• Demonstrate ability to perform highly advanced research; skills in problem identification and resolution.
• Ability to provide clear, concise and effective training.
• Detail oriented, accurate data entry and possess strong organizational and analytical skills.
• Intermediate skill using Microsoft Programs; Word, Excel, and Outlook.
• Strong oral, written, and interpersonal communication skills in English, including telephone etiquette.
• Ability to multi-task, handling varied responsibilities daily.
• Strong organizational skills
• Excellent interpersonal skills and ability to work with cross functional teams, internal and external stakeholders
• Ability to work independently

Preferred Qualifications:

• One to three years’ in project coordination/management
• Prior health care experience a plus

Physical Demands/Working Conditions:

• Requires operating computer workstation, including keyboard and video display terminal.
• 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: $22.00 - $26.00 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.