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Anthem, Inc. Liaison Support (myNEXUS) in Seven Hills, Ohio

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At myNEXUS, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care. myNEXUS is a technology-driven, care and benefit management service that enables individuals to live healthier lives in their homes. Our proven clinical model connects individuals to intelligent care delivering independence at lower costs. To maximize health delivery, we consistently leverage our: Innovative Technologies, Advanced Clinical Expertise, and Proprietary Network Engagement Platform. We are continuously pioneering ways to optimize health resources for our clients and their customers. Through our proprietary network management and engagement programs, we realize enhancements in quality, outcomes, and care effectiveness.

Job Summary: The Liaison Support performs a variety of duties. This position requires skill in planning, organizing and documentation of post decision activities. This person is responsible for processing and scheduling of requests for Peer to Peer reviews, as well as performing written and oral communication of post review outcomes. This role supports the Clinical Liaison role and assists with post decision activities. This position does not conduct any activities that require interpretation of clinical information.

Duties/Responsibilities: • Receives and coordinates requests for post review discussions and Peer to Peer reviews. • Assures that all requests for Peer to Peer review are received and processed in a timely manner in keeping with department policy. • Responsible for handling of inbound and outbound communication with physicians, home care agency representatives, and members and/or member representatives in relation to adverse medical decisions. • Using discretion and independent judgment in handling patient or physician complaints received, documents and forwards to appropriate administrative staff. • Documents all activity as directed and maintains electronic copy files as directed. • Escalates abnormal situations to supervisor, making recommendations for resolution. • Communicates with providers, patients, and family in a kind and professional manner. • Gives explanations and verbal reassurances to patient and family. • Interacts professionally with all, including co-workers and other healthcare providers. • Fosters communication among healthcare team on the behalf of the patient. • Proficient with myNEXUS systems, operations processes, data entry, and basic computer skills for generation of daily office communication and record generation. • Answers the telephone and patient/provider requests in a timely and polite manner. • Communicates ideas for improvement to the supervisor. • Demonstrate proficiency in meeting and exceeding all required departmental goals and objectives. • Reflects knowledge and judgment in decisions and actions within the job description of the Liaison Support.

Professional Responsibilities: • Completes all compliance related training and demonstrates compliance on the job. • Adheres to dress code, appearance is neat and clean. • Completes annual education requirements. • Maintains patient confidentiality as well as following all PHI guidelines and requirements at all times • Reports to work on time and from breaks as scheduled, completes work within designated time. • Follows all company policies related to time records and time off policies. • Attends annual review and department in-services, as scheduled. • Attends at staff meetings and one on one meetings as scheduled and reads all staff meeting minutes and other written documents as requested. • Represents the organization in a positive and professional manner. • Actively participates in performance improvement and continuous quality improvement (CQI/QA) activities and programs. • Complies with all organizational policies regarding ethical business practices. • Communicates and demonstrates the mission, ethics and goals of the Company, as well as the department. • Required Skills/Abilities: • Must be able to demonstrate team behavior and must be willing to promote a team-oriented environment. • Maintains complete and accurate patient care records within company platform. • Demonstrates high level customer service skills, both internally and externally. • Accepts additional assignments willingly. • Supports the Mission and the Core Values of myNEXUS • Performs other duties as assigned. • Ability to read and communicate effectively in English. • Additional languages preferred. • Ability to read, analyze, and interpret insurance and medical documents. Must understand and communicate effectively with providers and insurance representatives. • Ability to respond to common inquiries or complaints from providers, patients or family members. • Must demonstrate the willingness to work in a team environment and be a team player. • Possesses the ability to adjust to constantly changing work flows and processes. • Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to recognize clinical documentation form a verity of sources and determine the appropriate process to follow. • Shows proficiency with computer programs which may include Microsoft Word, Excel, PowerPoint, Outlook and others. • Strong administrative, clerical and organizational skills. • Excellent customer service and follow-up skills. • Strong attention to detail and accuracy.

Education and Experience:

  • High School diploma or the equivalent.

  • LPN Certification encouraged; not required

    Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

EOE.M/F/Disability/Veteran

REQNUMBER: PS51662

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