Workflow Coordinator - Etobicoke, Canada - Greenshield Holdings

Greenshield Holdings

Verified Company

Etobicoke, Canada

4 days ago

Posted by:

Sophia Lee

beBee Recruiter

Description

About Greenshield

Green Shield is the first integrated health services organization in Canada that is both a payer (offering insurance, administering benefits, and paying claims) and a provider (offering medical, mental health, and pharmacy services).

This evolution also deepens our social mission through both financial support and the direct delivery of services to support local communities and underserved populations across Canada.

As a part of Greenshield group of companies, Greenshield Administration provides innovative health benefit solutions for the small-mid size companies in Canada.

Recognized as the leading alternative to the traditional insurance companies, in a market where small and mid-sized employers have been largely underserved Greenshield Administration sets itself apart from the competition, by using technology, creative product development and a stellar customer experience to solve problems for employers.

Honeybee Benefits is our next generation benefits platform built for today's modern workforce that empowers employers to compete better for talent.

The Workflow Coordinator is responsible for delivering high-quality, service-oriented, professional outcomes to support claims processing.

As the Workflow Coordinator, you are responsible for coordinating workflow by processing incoming claims, conducting claims audits, developing reporting, analyzing prior authorizations, managing mail, and providing sundry support to claims processors.

You have the ability to effectively manage, execute, and delegate customer requests for services, and use discretion and judgment to assess client requests, gather appropriate additional information and determine if there are issues and concerns that must be escalated or client expectations managed.

Responsibilities and Accountabilities:

Administration: This requires coordination with colleagues, an expert knowledge of benefit services and processes, and a working knowledge of support software
Sorts the mailedin claims ensuring it would be easy for the adjudicators to read and key in the claims
Executes all requests for escalation to specific departmental groups/specialists
Responsible for maintaining exceptional working knowledge of crossspecialty service offerings
Provide input and improve the workflow processes and procedures for all Prior Authorizations (PAs). Maintain a sense of urgency and respond to and followup on PA requests in a timely and efficient manner. Generate departmental reports and use or distribute as needed.

a) Approved PAs

Review the approved PAs from ESC
Create the Checklist
Send request for approval
Send approved PAs for coding
Track the approved PAs

a) Declined PAs

Send respond to ESC to mail decline letter
Track the declined PAs
Misdirected PA
Forward to customer care to reach out to the member
Appeals
Review the appeal basing on the information from ESC
Send evaluation for further review and decision

b) Monthly PA reconciliation

Review the monthly statement from ESC
Send to Finance with recommendation

Accountabilities:

Maintain working knowledge and understanding of current and historical Benecaid products by assisting and managing the Drug Formularies (BN01G, BNFG, BN01 and EQFG).
Attend the monthly validation meetings hosted by ESC
Take notes on the important provincial initiatives or changes and determine the impact to Benecaid
Determine if the drugs reviewed during the Validation meeting needs to be removed from the Benecaid Formularies
Send request to ESC to remove DINs
Send out the Validation meeting notes
Monthly DIN additions
Update the Tracking Sheet with the necessary information
Send the updated sheet for review
Send request to remove or add DINs basing on the review
Attend review meetings
Equitable Formulary: EQFG
Determine the excluded/included DINs on the Exclusion Lists sent periodically by Equitable
Send request to ESC for coding

Skills, knowledge and experience:

13 years of experience in customer service or a related role
Knowledge of the insurance industry and relevant federal and state regulations
For French Bilingual, written, and oral communication skills required
Proficient in Microsoft Office
Selfstarter with demonstrated ability to prioritize case load
Excellent data entry skills
Excellent verbal and written communication skills to effectively communicate with internal and external clients
Ability to work collaboratively as a team and/or independently
Ability to exercise flexibility, initiative, good judgement, and discretion
Excellent organizational and interpersonal skills
Attention to detail
Selfmotivated to effectively multitask and be comfortable with tight deadlines; results oriented
Analytical with a problemsolving attitude