Your Role The Social Programs team is responsible for the support, oversight and administration of Social Programs benefits and services ensuring that our eligible members receive appropriate services in-line with benefits and services that is member-centered and in the communities where our members seek care. The Program Coordinator, Associate will report to the Senior Manager, Program Management Clinical. In this role you will play a key role in supporting administrative and operational organization while regularly providing support and assistance to our Providers (Community Health Worker, Enhanced Care Management, Community Supports, and Community Based Adult Service Providers) to facilitate their ability to provide the full scope of the Medi-Cal benefit and/or services to our members.
Your Work In this role, you will: - Support business objectives, unit processes, and administrative efficiency under the guidance of Program Managers and/or leaders, ensuring that all state and federal rules and regulations are followed.
- Assist in organizing inter-departmental activities and supports operational responsibilities providing administrative/clerical support.
- Review referrals to determine member eligibility for the for Social Programs benefits and services, processing daily service authorizations and denials for requested benefits and services.
- Perform data entry, tracking and case documentation for all members referred for services, including enrollment status, authorizations, encounter data, activities, clinical case records and regulatory reports.
- Support with reconciling provider claims.
- Facilitate timely Provider submission of deliverables and reports and conduct review of said deliverables and reports to ensure accurate data collection and reporting.
- Support with implementation of training to internal teams, external providers, and community-based organizations by providing ongoing education about the benefits, services and the referral process.
- Follow up with internal staff and providers to support the successful referral and enrollment of members into Social Program's benefits and services.
- Conduct outreach calls to members, as needed, to verify engagement in benefits and/or services.
- Perform other assigned duties, as required.
Your Knowledge and Experience - Typically, requires a college degree or equivalent experience and 2 years prior relevant experience.
- Requires a broad knowledge of operational systems and practices typically gained through extensive experience and/or education.
- Desired minimum two (2) years of experience with managed care plan.
- Prefers experience partnering with provider groups and community resources and agencies
- Prefers skill in implementing operational aspects of programs and policies with ongoing process improvements
- Prefers strong administrative skills including proficiency in Excel, Microsoft Word and Microsoft Outlook and the ability to multitask and track multiple projects/deliverables at one time
- Prefers experience communicating effectively to leadership and peers
Pay Range The pay range for this role is: $ 27.94 to $ 39.11 for California.
Note Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.