Job DescriptionJob Description

The Web Inquiry Support Coordinator provides effective web communication between MSO, IPA providers, health plan representatives to coordinate member care. Communication to include accessibility to care, validating contract, modification request and ensuring timeliness standards are met. The Web Inquiry Support Coordinator reports directly to the Outpatient Lead Coordinator under the guidance of the Supervisor.

Duties and Responsibilities:

• Daily processing of 120 web inquiries daily
• Provide outstanding written communication
• Identifies providers who show an educational need to follow State, Federal and plan requirements
• Appropriately forwards referral request to the clinician for review as needed
• Timely response to web inquiry submissions per UM department turnaround time
• Responsible for modification request per coordinator hierarchy grid
• Provides effective departmental communication with both internal and external sources
• Process authorization requests per state and federal timeliness regulations
• Research member history for duplication request
• Request submission of appropriate of appropriate medical records according to requested services
• Validate data entry process for errors
• Verify member benefits and eligibility upon receipt of web inquiry request
• Utilizes authorization matrix, ancillary rosters, DOFR and/or delegation agreement
• Coordinates with referral Clinician and/or Medical Director for timely processing
• Maintain knowledge of CMS & Medi-Cal policy guidelines i.e. Medicare LCD vs NCD
• Identify & inform Case Management Clinician on complex care diagnoses
• Screen cases for possible California Children Services (CCS) eligible condition
• Collaborate with other departments (i.e. Claims, PNO, etc.) to resolve member/provider matters as needed
• Data entry for additional requested services, as needed
• Assist with special projects, as needed
• Assists other team members with their workload, as needed
• Regular attendance at UM team meetings

Minimum Job Requirements:

• High School graduate or GED equivalent
• One-year medical office experience
• Knowledge of medical terminology
• Proficiency in Microsoft Office programs, especially Word and Excel
• Proficiency in EZCAP a plus

Skills and Abilities:

• Ability to multi-task while remaining adaptable and flexible to fast-paced environment
• Reliable, dependable, and accountable
• Strong customer service skills with good telephone rapport
• Ability to empathize with complex cases
• Self-Motivation and ability to work effectively in an independent environment
• Great critical thinking and problem-solving skills