Restricted Recipient Support Coordinator

Summary

Blue Cross and Blue Shield of Minnesota is committed to helping people achieve their healthiest lives through healthcare services. The Restricted Recipient Support Coordinator supports the Restricted Recipient Program by managing referrals, triaging calls, completing administrative requests, entering restriction information, and coordinating with members, providers, pharmacies, and program leadership.

Responsibilities

• Prioritize RRP program referrals through system work queue management, mailbox management, daily activity reports, incoming telephonic referrals and any other method deemed necessary for member program enrollment
• Review referrals for completeness of information and attempt to resolve when appropriate (eligibility information, accurate phone number, etc.)
• Ensure Restricted Recipient Program Specialists receive referrals or other information in a timely manner and according to established practices, workflow processes and departmental needs
• Accurately apply specific guidelines, policies and procedures as authorized by medical management
• Completes all system documentation per process and regulatory standards within Medical Management, DHS, and external vendor systems
• This role will be responsible for all restriction information data entry in accordance with DHS administrative rules and guidelines. Triage all incoming calls from members and providers regarding RRP
• RRSC's must be able to apply program rules to incoming exception requests and complete administrative exceptions per established Medical Management and DHS guidelines
• Complete outbound calls to providers and facilities per established guidelines or as directed by Restricted Recipient Program Specialists or the Medical Director
• Recognize opportunities for improvement and initiate workflow changes in collaboration with leadership and staff. Demonstrate the ability to modify approach based on customer demands
• Actively participate as a member of a team and provide input to assure that quality standards and continuous quality improvement activities are met. Accept accountability for more complex assignments and special projects that require moderate to complex research, analysis and documentation skills
• May assist manager with daily workload balancing and other work inventory assignment tasks
• Performs additional responsibilities consistent with the scope and level of the role, as assigned

Skills

• 4+ years of experience in related role or 2+ years internal experience
• High school diploma (or equivalent)
• Ability to communicate detailed information to diverse audiences, actively listen to understand varied perspectives, and facilitate alignment on operational priorities
• Ability to analyze complex operational issues, evaluate tradeoffs, and collaborate with stakeholders to reach effective, sustainable solutions
• Ability to organize work across multiple assignments, balance shifting priorities, and manage time to meet commitments while supporting team coordination
• Healthcare experience and/or knowledge of the managed care and health care/insurance industry
• Experience with healthcare regulations including Mental Health Parity (MHPAEAA) Federal Regulatory requirements and applicable state laws
• Medicaid and commercial insurance experience
• Understanding of population health management trends, clinical program design, and healthcare market dynamics
• Experience developing and implementing strategy and strategic initiatives
• Process improvement and ability to implement tools or systems that improve team efficiency and accuracy
• Understanding of medical claims and coding

Qualifications

Must Haves

• 4+ years of experience in related role or 2+ years internal experience
• High school diploma (or equivalent)

Nice to Haves

• Ability to communicate detailed information to diverse audiences, actively listen to understand varied perspectives, and facilitate alignment on operational priorities
• Ability to analyze complex operational issues, evaluate tradeoffs, and collaborate with stakeholders to reach effective, sustainable solutions
• Ability to organize work across multiple assignments, balance shifting priorities, and manage time to meet commitments while supporting team coordination
• Healthcare experience and/or knowledge of the managed care and health care/insurance industry
• Experience with healthcare regulations including Mental Health Parity (MHPAEAA) Federal Regulatory requirements and applicable state laws
• Medicaid and commercial insurance experience
• Understanding of population health management trends, clinical program design, and healthcare market dynamics
• Experience developing and implementing strategy and strategic initiatives
• Process improvement and ability to implement tools or systems that improve team efficiency and accuracy
• Understanding of medical claims and coding

Benefits

• Fully remote work arrangement
• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)