Care Coordinator II (Insurance) Job at Tia
Role Title: Care Coordinator II (Insurance)
Manager: Lead, Insurance (Kim St. Phard)
Location: Virtual
Availability: Weekdays, Full-time
Role Summary: As a Tia Care Coordinator, you will be every Tia member's partner in their health and wellness journey- helping them navigate both the healthcare system and ensuring that they are getting a concierge-level experience at Tia. You'll also partner with teams across the company to empower providers to focus on members' care and support overall business needs.
Core Values:
- Ask why. Then why, again.
- Act as a pack, not a lone wolf; Teamwork centric but with respect for top down directives when necessary.
- Find your superpower.
- Insist on diversity.
- Ownership mentality.
- Be compassionate.
- Find joy and gratitude everyday.
Abilities:
- Interpersonal communication & empathy
- Working cross functionally
- Strongly adheres to process
- Creative & open minded
- Comfortable with a fast-paced environment and frequent change
- Can navigate ambiguity and dive into new workflows without all processes
- Solution-oriented: Will seek answers to your questions, whether through SOPs or through other team members.
- Detail-oriented
- Relationship building
- Clear & concise communications
- Energized by metrics
Required Skills:
- 1+ years of experience in a medical billing office, medical office setting, or insurance company
- Working knowledge of CPT, ICD-10, and HCPC coding
- Familiarity with payer authorization processes including interfacing with payers via calls, fax, or portals
- Attention to detail and deadlines
- Customer service skills
- Proficiency in MS/Google Suite
- Willingness to learn new technologies & frameworks
- Developing processes where needed and driving for continuous improvement
- Experience with nuances of members requests, and able to effectively prioritize them
- Balancing multiple stakeholders including care team, members, and the business
- Experience working in a high growth environment and comfortability jumping into new processes
Responsibilities:
- The insurance Care Coordinator II obtains insurance prior authorizations for medical procedures and re-authorizations as required; appeals prior authorization denials and helps facilitate peer-to-peer reviews as needed
- Process patient prior authorizations
- Establish and document medical necessity requirements per insurance policies
- Appropriately document authorization details of benefit limitations and authorization status
- Meet or exceed productivity expectations after orientation period to ensure requests are being processed timely
- Monitor pre-auth denials for trends and provider documentation issues and escalate to Lead or Supervisor as appropriate
- Escalate any issues or concerns to the appropriate department or manager as necessary
- Maintain strictest confidentiality
- Day-to-day member communications - managing member questions & feedback, and resolving member concerns (chat & phone support).
- Triage member communications appropriately
- Manage inbound members messages, ensuring proper prioritization across various types of messages
- Ensure if we cannot answer the members' needs that we connect them. immediately to someone who can i.e. urgent needs, clinical needs, etc.
- When performing any handoffs to another team member, do so by providing both the members and other Tia team members full context.
- Ensure each member's message is responded in a personal, empathetic way while adding context and informing members about their options in their healthcare.
- Solution-oriented mindset - will work to ensure Tia can support all members requests, no matter how difficult.
- Ensures all messages are responded within agreed-upon turnaround time, and ends every day with 0 outstanding action items.
- Maintain a clean & organized chat queue with an ownership mentality.
- Demonstrates accountability for chats.
- Ensuring members needs get met and ensuring that if a member expresses concerns, that we follow internal processes to ensure they get addressed.
- Manage coordination of care across the healthcare system
- Act as a team, not a lone wolf, with care team to ensure efficient escalation of members needs, including but not limited to:
- Ordering birth control devices from Specialty Pharmacies
- Prior authorizations for prescriptions, procedures and services
- Billing and insurance concerns, etc.
- Manage coordination of care within Tia's ecosystem, working cross-functionally across different teams to ensure members needs are met.
- Enable providers to focus on their highest impact work, by providing administrative support on key clinical process, including but not limited to:
- Checking insurance coverage for healthcare services provided at Tia
- Membership questions,
- Tech troubleshooting, etc.
- Execute on core competency with respect to pod responsibilities and assigned individual responsibilities.
- Find your superpower to double down on a key area of the care coordination job to execute on. Examples:
- Checking insurance eligibility and network status
- Checking insurance coverage for healthcare services
- Day-to-day charges of copays; charging outstanding patient responsibilities after claims are finalized
- Following-up with members who have outstanding balances
- Creating & facilitating lab requisitions or imaging referrals
- Ordering birth control devices and scheduling special appointments
- Prior Authorizations for medications
- Sorting lab and imaging results, and triaging to ordering providers or nurses
- Billing & Insurance
- Clinical Services
Benefits
- Talented and collaborative team who will both support and challenge you.
- 401k
- Medical and dental benefits
- Paid holidays, robust vacation, and sick leave
This position may require attendance at company and team off-sites and is subject the Company's vaccine requirement, as permitted by law and subject to reasonable accommodation.
If you are committed to collaborative problem solving, creating high-quality and user-centric products, and want to make waves in women's healthcare, join us!
Founded in 2017 by Carolyn Witte and Felicity Yost, Tia is the modern medical home for women. We are trailblazing a new paradigm for women's healthcare that treats women as whole people vs. parts or life stages. Blending in-person and virtual care services, Tia's "Whole Woman, Whole Life" care model fuses gynecology, primary care, mental health and evidence-based wellness services to treat women comprehensively. By making women's health higher quality and lower cost, Tia makes women healthier, providers happier, and the business of care delivery stronger — setting a new standard of care for women everywhere.
Tia has raised more than $132 Million in venture capital funding to date, including a recent $100 Million Series B investment, one of the largest early-stage rounds ever for a healthcare company focused on women. Tia has ambitious plans to scale its "whole-woman, whole-life" model to more than 100,000 women by 2023. We'll do this by growing virtual and in-person operations in existing and new markets while expanding its service lines to care for women throughout their entire lives - from puberty to menopause. Since launching in 2017, Tia has grown to serve thousands of women aged 18-80 with blended in-person and virtual care in New York City, Los Angeles, Phoenix and soon San Francisco.
We're building a world class team to reimagine women's healthcare. We're an interdisciplinary team of clinicians, researchers, designers, technologists and operators who have seen firsthand how broken the healthcare system is for women. We're united by a powerful mission to enable every woman to achieve optimal health, as defined by herself, as well as a shared set of values and principles that define our business, products, and culture.
Tia is building a culture of excellence — in people, process and product. This is our northstar value;
What is excellence, exactly?
Excellence about constantly elevating yourself, it is the process of constantly striving to perform to the best of your abilities, and identifying your top potential through constant learning, experimentation and evolution. Excellence is not about achieving perfection, as that insinuates a pinnacle. Instead, in our terms, excellence is about the pursuit of constant improvement. We're looking for people who want to go on that hard journey of constantly setting new personal records, and organizational records.
We practice excellence at Tia by demonstrating the following types of behaviors: We chose (and actively choose) excellence as Tia's highest order value because it crystalizes into one word several behaviors that we hold dear, specifically:
- A drive to constantly improve through experimentation, reflection. and an insatiable growth mindset — said another way, we're energized by the possibility of invention, innovation, and iteration
- Being present in and grateful for the journey — not just the goal line. Perfection is static. Excellence is a process (more on this important distinction below)
- Asking why, then why again — because accepting "this is just the way it is" is not good enough
- Grit & perseverance — a maker mentality that involves "rolling up your sleeves", but also deep care for oneself and for others
- A commitment to uncovering talents to unlock "rock star" potential across every individual
Furthermore, excellence reflects the "bigness" and the "boldness" of Tia's mission and vision — a world in which every woman can achieve optimal health, as defined by herself.
Said another way, Tia's mission is NOT to make healthcare incrementally better for women. Instead, we've intentionally set out to create a fundamentally new paradigm for modern women's healthcare that's truly excellent. We believe that creating a company that operates in a culture of excellence will manifest in our product. Reaching this goal is not an overnight pursuit or a "one and done." We have not and will not "get it right" with the first swing. Rather, this higher order goal is a moving target — one we have not and will not ever fully "achieve." By design, we will never be "done" with this work, but instead, we will be continuously in pursuit of our mission. It is this continuous pursuit — the journey, not the finish line — that truly embodies excellence.
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