Excellus Health Plan Inc.
Rochester, NY, USA
Job Description: Summary: This position supports the workflow of the Medical Services division. Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization Management, Behavioral Health, Quality Management, or Member Care Management. This position acts as a resource for staff regarding members' specific contract benefits, consistent with products, policies and procedures and related health plan functions such as member services, claims, and the referral process. As well as functions related to legislative and federal regulatory mandates related to the Health Plan Essential Accountabilities: Level I Review / prep clinical case for clinical staff. Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to provide support to the division. Serves as the primary contact for providers regarding authorization, information...