At Magellan Health, 10,000 people wake up every day determined to help our members. We do this by connecting behavioral, physical, pharmacy, and social needs into a complete picture of the care that’s personalized, coordinated, and cost-effective. By turning fragmented care into focused care, we empower 1 in 10 Americans to lead healthier, more vibrant lives. Read employee reviews, salaries, and benefits here
District of Columbia, Arizona, Jacksonville, Florida, Missouri, Texas, Virginia,
Responsibilities include documenting in the appropriate systems and ensuring high-quality and accurate information is provided to callers. This role is expected to meet or exceed operations production and quality measures.
Understand the end-to-end authorization process, the SBU's business and business drivers for success.
Actively listens and probes callers in a professional and timely manner to process authorizations and/or other customer service requests working towards first call resolution.
Researches and communicates information regarding member eligibility, provider status, and authorization inquiries to callers while maintaining confidentiality.
Resolves customer complaints or concerns as the first line of contact.
Makes problem resolution and triage decisions not requiring clinical judgment.
Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
Transfers call to clinicians and physicians only for clinically escalated situations.
Communicate appeal and denial language to providers and members when appropriate.
Processes withdrawals and other case status change as needed.
Understands client and regulatory expectations for accounts in their designated region.
Recognizes and develops relationships with provider groups through repeat calls, and recognizes provider sensitivities for different health plans.
Is responsible for reading and retaining information disseminated through multiple resources, ensuring calls are handled accurately and appropriately per current account information.
Processes fax attachments in between calls.
Responsible for meeting SBU's Service standards in all categories on a monthly basis, team player, maintaining member and provider Confidentiality at all times, demonstrating effective problem-solving skills, and being punctual, and maintaining good attendance.
Participates in SBU's Service Operations activities as requested that help improve Care Center performance, excellence, and culture.
Supports team members and participate in team activities to help build a high-performance team.
Demonstrates flexibility in areas such as job duties and schedule in order to aid SBU's Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.
Assists SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assumes responsibility for self-development and career progression.
Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.
Actively listens and probes callers in a professional and timely manner to determine the purpose of the calls.
Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assists in the mentoring and training of new staff.
Assumes full responsibility for self-development and career progression; proactively seeks and participates in ongoing training sessions (formal and informal).
Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care, and Utilization management programs.
Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
Educates providers on how to submit claims and when/where to submit a treatment plan.
Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
Informs providers and members of Magellan's appeal process.
Leads or participates in activities as requested that help improve Care Center performance, excellence, and culture.
Links or makes routine referrals and triage decisions not requiring clinical judgment.
Performs necessary follow-up tasks to ensure member or provider needs are completely met.
Provides information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers.
Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
Refers patients/EAP clients to Magellan's Care Management team for a provider, EAP affiliate, or Facility.
Responsible for updating self on ever-changing information to ensure accuracy when dealing with members and providers.
Support team members and participate in team activities to help build a high-performance team.
Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
Other Job Requirements
Responsibilities
Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
Must agree to observe service for the purpose of training and quality control.
Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
Must be able to maneuver through various computer platforms while verifying information on all calls.
Must be able to talk and type simultaneously.
Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.
Listens and probes callers in a professional and timely manner to determine the purpose of the calls.
Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
Resolves customer administrative concerns as the first line of contact this may include claim resolutions and other expressions of dissatisfaction.
Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assists in the mentoring and training of new staff.
Assumes full responsibility for self-development and career progression; proactively seeks and participates in ongoing training (formal and informal).
Assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care, and Utilization management programs.
Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
Educates providers on how to submit claims and when/where to submit a treatment plan.
Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
Informs providers and members of Magellan’s appeal process.
Leads or participates in activities as requested that help improve Care Center performance, excellence, and culture.
Links or makes routine referrals and triage decisions not requiring clinical judgment.
Performs necessary follow-up tasks to ensure member or provider's needs are completely met.
Provides information regarding Magellan’s in-network and out-of-network reimbursement rates and states multiple networks to providers.
Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
Refers patients/EAP clients to Magellan’s Care Management team for a provider, EAP affiliate, or Facility.
Updates self on ever-changing information to ensure accuracy when dealing with members and providers.
Supports team members and participate in team activities to help build a high-performance team.
Documents customer's comments/information and forwards required information to the appropriate staff.
Other Job Requirements
Responsibilities
Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
Must agree to observe service for the purpose of training and quality control.
Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
Must be able to maneuver through various computer platforms while verifying information on all calls.
Must be able to talk and type simultaneously.
This position is responsible for providing assistance with the resolution of authorization and/or claim issues in various work queues resulting from and calls taken from facilities and providers. Acts as liaison between providers, internal departments, and specific accounts, clients, and claims department.
Resolves cases in the queue due to member eligibility issues, referring provider verification or request, imaging provider verification, redirection, and retro reviews.
Assists with authorization problem resolution through research and facilitating the resolution of the problem in a timely fashion.
Process, forward, trend, and maintain records of authorization issues.
Acts as a troubleshooter to resolve problems among internal departments.
Handles special requests from Customers requiring manual workarounds or special projects.
Investigates written/verbal complaints involving authorizations, and resolves complex issues with Customers and Providers.
Assists specific accounts that have special processes.
Observes and tracks authorization problem trends and works with the internal department for resolution.
Assists with User Acceptance Testing (UAT).
Provides phone backup coverage for other teams as needed.
Other Job Requirements
Responsibilities
Ability to review and interpret multiple contract/account information to successfully resolve issues regarding benefit plan administration; experience with account benefit structures.
Demonstrated ability for problem-solving, meeting deadlines, initiative, and follow-through.
Excellent written and verbal communication skills.
Knowledge of pharmacy benefits management.
Understanding of customer service performance metrics (ASA, abandonment rate, talk time).
The primary function is to supervise the customer care staff responsible for responding to telephone inquiries from providers and members as they relate to eligibility, benefits, claims, and authorization of services. Supervises the staff in the implementation, servicing, and maintenance of accounts and account-related activities.
Directs all tasks related to product/services operations and all performance standards are met.
Directs all tasks related to Mailroom operations and all performance standards are met.
Directs all tasks related to provider call center operations including ensuring all performance standards are achieved such as; speed to answer, call abandonment rate, etc. Develops and executes outreach strategy to support recruitment or other activities.
Lead team in successful delivery and execution of services to meet client and internal stakeholder commitments, contractual obligations and regulatory requirements
Responsible for department budget functions ensuring necessary resources are available and efficient, cost-saving use of those resources
Other duties as assigned.
Other Job Requirements
Responsibilities
Minimum 5 years in a call center environment.
Must possess Service Excellence attitude.
Experience leading large teams in a dynamic industry.
Demonstrated track record of managing change with proven results in the achievement of customer service goals.
Knowledge of managed healthcare principles and call center operations.
Ability to identify individual and team developmental needs.
Ability to effectively coach and develop team members.
General Job Information
Title
Supervisor, Provider Services
Grade
22
Work Experience - Required
Customer Service, Supervisory
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