Post Acute Care (PAC) Case Administrator - Evernorth - Remote

About the position

The Post Acute Care (PAC) Case Administrator plays a crucial role in delivering administrative and business services within the Customer Service department. This position is primarily focused on maintaining workflow activities for the PAC Health plan product, facilitating inbound and outbound communications between eviCore Healthcare stakeholders and external hospitals, physicians, and Post-Acute Care providers. The administrator is expected to demonstrate a comprehensive understanding of the pre-certification process and address day-to-day operational concerns by adhering to defined processes. A key responsibility of the PAC Case Administrator is to ensure compliance with both Medicare and Medicaid guidelines by state regulations. This involves communicating state-specific and national healthcare laws to external stakeholders, including appeals and reconsideration policies. The role requires effective coordination of requests from hospitals and providers for pre and re-certification, as well as managing status checks on existing cases. The administrator will also handle notification calls regarding incomplete pre-certification requests and authorization approvals. In addition to communication tasks, the PAC Case Administrator will receive and process faxed information from various stakeholders, ensuring that requests are completed accurately and efficiently. The position also involves evaluating client trends and collaborating with internal stakeholders to address and resolve issues through effective communication. As part of a call center environment, the administrator will spend a significant portion of their shift on the phone, providing excellent customer service and ensuring that clients and providers fully understand the resolution or action plan. The role requires flexibility in work hours, including potential weekend and holiday coverage, and the ability to work independently with minimal supervision.

Responsibilities
• Maintain workflow activities for the PAC Health plan product for inbound and outbound communications.
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• Demonstrate understanding of the pre-certification process and resolve operational concerns.
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• Differentiate Post-Acute Care processes across multiple health plans and ensure compliance with Medicare and Medicaid guidelines.
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• Communicate state-specific and national healthcare laws to external stakeholders.
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• Coordinate inbound requests for pre and re-certification, status checks, and direct calls to internal departments.
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• Notify hospitals and providers regarding incomplete pre-certification requests and authorization approvals.
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• Receive and process faxed information from hospitals and providers, creating and managing cases accordingly.
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• Evaluate client trends and partner with internal stakeholders to address issues.
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• Provide excellent customer service to clients and providers, ensuring understanding of resolutions.
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• Navigate multiple platforms containing provider data, member information, and authorizations.

Requirements
• High School graduate with diploma or GED; Associates or Bachelor's degree preferred.
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• 2+ years of experience in healthcare contact center or customer service preferred.
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• Medical background with Post-Acute Care experience preferred.
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• Experience with insurance products including Managed Care, Medicare Advantage, Medicare, and Medicaid preferred.
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• Proficient with Microsoft Outlook, Word, Excel, and PowerPoint.

Nice-to-haves
• Ability to manage time and resources efficiently.
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• Excellent organizational skills.
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• Ability to provide clear verbal and written information to customers and co-workers.
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• Ability to work independently with little to no supervision.

Benefits
• Medical, vision, and dental insurance coverage starting on day one.
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• 401(k) with company match.
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• Company paid life insurance.
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• Tuition reimbursement.
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• Minimum of 18 days of paid time off per year and paid holidays.
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• Annual bonus plan eligibility.

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