HIP Customer Relations Coordinator III

Job Purpose:

The Health Insurance Program Customer Relations Coordinator performs a variety of functions; such as face-to-face contact with clients, assisting clients with applications and insurance needs, researching premiums for bookkeepers, communicating directly with Health Insurance Program Coordinator to resolve any client issues, and monitoring/delivering faxes appropriately. 

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Essential Job Functions including, but not limited to:

1. Satisfies Core Competencies

    Accepts responsibility for ensuring that performance meets the standards of the professional, ethical and relevant legislated requirements 

1. Eligibility and Data Management
   • Process add/change forms and churn notices per approval from LAHAP.
   • Research information based on the Ramsell report ran daily and divided between Health Insurance Program Assistant.
   • Report any discrepancies to LAHAP when applicable.
2. Claim Management
   • Research claims using the accounting spreadsheets ensuring non-duplication of payments.
   • Research claims using Ramsell to ensure client eligibility during date of service. 
   • Match claims and explanation of benefits to verify cost-share amount.
   • Forward all ineligible claims to data entry for tracking purposes and mailing of denial letters to providers, clients, and/or case manager. 
3. Client Management
   • Open ticket and research inquiry
   • Forward detailed ticket to HIP Accounting Bookkeeper when premium payments are needed.
   • Close tickets once the inquiry has been answered or resolved.
   • Respond to inquiries received by phone from clients and providers.
4. Other Duties
   • Adhere to departmental policies, procedures and objectives
   • Maintain patient confidentiality and comply with all federal and state health information privacy laws.
   • Performs related duties as assigned

Required Education:

   A high school diploma required; Associate degree in accounting or business preferred or four to six years accounting experience.

PHysical Demands: 

The physical demands described here are representative of those that must be met by the employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard reach
• Specific vision abilities required by this job include close vision requirements due to computer work
• Light to moderate lifting is required

Work Environment: 

The work environment characteristics described here are representative of those the employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Moderate noise (i.e. business office with computers, phone, and printers, light traffic).
• Ability to work in a confined area.
• Ability to sit at a computer terminal for an extended period of time.

Travel or Special Requirements:

Driving during the workday as well as local or out of state travel may be required to perform job duties.