Under general supervision, assists with the day-to-day operations of the Denver Health Medical Plan. Identifies, researches, and resolves complex problems by assisting members and providers in resolving their health plan related issues. Effectively makes decisions regarding whether member or provider information meets requirements for programs when circumstances require exceptions from, or interpretations of, rules, regulations or policies. Follows escalation procedures, and assists with documenting and tracking appeals and grievances. Collaborates directly with both internal and external partners such as State entities, other departments and community organizations.
**Call Center Environment**
Education and Experience
1. Graduation from High School or GED Certificate. Associates Degree Preferred
2. Two years Health Plan or customer service experience.
Knowledge, Skills and Abilities
1. Knowledge of health care administration, including managed care, Medicaid, Medicare, Exchange and CHP+ eligibility and enrollment policies and processes.
2. Knowledge of federal and Colorado statutes, legislative initiatives and regulations, as well as federal, state and local policies.
3. Skilled in analytical thinking, problem solving, and process improvement.
4. Skills in providing excellent customer service.
5. Ability to communicate effectively.
6. Ability to disseminate program information, policies, rules and/or regulations.
7. Ability to simultaneously coordinate and manage several functions, programs, and projects in various stages of completion.
8. Ability to consistently implement program, department and organizational policies and procedures.
9. Ability to work in teams to get projects done, and to work with those at all levels of the organization.
Computers and Technology
1. Knowledge of PC applications, specifically Microsoft Office products, and the ability to learn new computer applications.
2. Knowledge of health plan information systems, preferably QNXT and MMIS.
Denver Health Medical Plan
Full time, Days, Evenings, and Rotating Weekends
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."
Internal Number: 918
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.