Job Description

Imagine360 is currently seeking a Medical Management Support Specialist to join the team! The Medical Management Support Specialist will assist the Medical Management Supervisor by supporting non-clinical tasks and/or projects as assigned.

*Bilingual (Spanish speaking) preferred

*One late date per week as needed (the shift itself may vary depending on the staff members time zone and the time zone of the calls they need to make. Will discuss on phone screens and interviews in greater detail.

Position Location: 100% remote

Duties/Responsibilities:

• Assist Medical Management Supervisor, Managers, and Clinicians with non-clinical tasks as instructed by the direct supervisor.
• Assigns cases to the appropriate clinical employee, following approved criteria for case assignment; will also transfer non-clinical data as well as structure clinical data, as directed by clinical and non-clinical supervisor(s).
• Communicates professionally with external providers and vendors to assist with case documentation, requesting clinical documents for clinical staff review.
• Following a script, completes non-clinical outreach calls to clients to gather information related to program enrollment, as instructed by Supervisor.
• Assists with Stop Loss communication by sending Stop Loss letters to the Stop Loss Carriers as instructed.
• Monitor specific department email inboxes and assign cases to clinical employees and direct communications received to the appropriate employee as instructed by Supervisor.
• Pull program satisfaction survey results and distribute to appropriate employees as needed.
• Run and assemble internal and external reports as instructed.
• Maintain inventory of education and resources for the team.
• Mail letters and education material for Medical Management programs to members.
• Process returned mail for Medical Management.
• Prepare & maintain new hire binders as needed.
• Help organize and attend scheduled meetings and trainings for the department or company via teleconference or in person.
• Process participant assessments as assigned.
• Work collaboratively within a team setting to provide positive outcomes for members, clients, peers, and overall operations.
• Performs all tasks in accordance with Medical Management policies and procedures and HIPAA/PHI guidelines and follows the policies and procedures as it relates to escalating issues within the staff hierarchy and between clinical and non-clinical staff.
• Completes all tasks on time and with accuracy.
• Participate in quality program as assigned.
• Perform all tasks in accordance with HIPAA/PHI guidelines.
• Complete HIPAA training annually.
• Perform other duties as assigned.

Education and Experience:

Required Education:

• High school diploma or equivalent is required. 

Required Experience:

• 0-1 + years' experience working in an administrative support role.
• Experience working with Microsoft Office including Word, Excel, and PowerPoint.
• Experience navigating the internet and using database software.

Preferred Experience:

• Prior experience working in an administrative support role specifically supporting non-clinical healthcare operations preferred.

Skills and Abilities:

• Ability to maintain a high level of accuracy and attention to detail to perform each essential duty satisfactorily.
• Ability to read and interpret documents such as HIPAA compliance, safety rules, operating and maintenance instructions, and policy and procedure manuals.
• Ability to write routine reports and correspondence.
• Strong verbal and written communication skills.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages.
• Ability to apply concepts of basic mathematics and fundamental accounting principles.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems and exercise sound judgment involving several concrete variables in standardized situations.
• Advanced knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software.  

Physical Requirements:

Work Environment:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job indoors. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• The noise level in the work environment is usually very quiet.

Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• This position involves no physical exertion beyond the normal office environment and the employee must occasionally lift and /or move up to 10 pounds.
• Specific vision abilities required by this job include Close vision, Distance vision, Peripheral vision, Depth perception and Ability to adjust focus. Also requires a high degree of visual concentration for reviewing and compiling large quantities of computer-based data from several sources.
• The employee regular uses hearing for gathering information.
• While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arms. The employee is occasionally required to stand and walk.

What can Imagine360 offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**