Restricted Recipient Support Coordinator

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

* The hours for this role are 8:30 - 5 PM CT with no flexibility in time

How Is This Role Important to Our Work?

The Restricted Recipient Support Coordinator (RRSC) role is designed to support the Restricted Recipient Program Specialist and the Restricted Recipient program (RRP). The RRSC's support the program specialists by managing the incoming referrals for potential RRP members, triaging incoming calls from members and providers regarding the RRP program, completing administrative requests, and in completing all data entry for restriction information in multiple systems. The RRSC's also have direct contact with members who are enrolled in the RRP program, as well as clinical providers and pharmacies who provide care to these members. RRSC's may also outreach to providers or hospitals on behalf of the Restricted Recipient Program Manager or Medical Director.

A Day in the Life:

• Prioritize RRP program referrals through system work queue management, mailbox management, daily activity reports, incoming telephonic referrals and any other method deemed necessary for member program enrollment.
• Review referrals for completeness of information and attempt to resolve when appropriate (eligibility information, accurate phone number, etc.).
• Ensure Restricted Recipient Program Specialists receive referrals or other information in a timely manner and according to established practices, workflow processes and departmental needs.
• Accurately apply specific guidelines, policies and procedures as authorized by medical management.
• Completes all system documentation per process and regulatory standards within Medical Management, DHS, and external vendor systems.
• This role will be responsible for all restriction information data entry in accordance with DHS administrative rules and guidelines. Triage all incoming calls from members and providers regarding RRP.
• RRSC's must be able to apply program rules to incoming exception requests and complete administrative exceptions per established Medical Management and DHS guidelines.
• Complete outbound calls to providers and facilities per established guidelines or as directed by Restricted Recipient Program Specialists or the Medical Director.
• Recognize opportunities for improvement and initiate workflow changes in collaboration with leadership and staff. Demonstrate the ability to modify approach based on customer demands.
• Actively participate as a member of a team and provide input to assure that quality standards and continuous quality improvement activities are met. Accept accountability for more complex assignments and special projects that require moderate to complex research, analysis and documentation skills.
• May assist manager with daily workload balancing and other work inventory assignment tasks.

Nice to Have:

• Associate degree.
• Experience with Medicaid population and DHS MMIS system.
• Working knowledge of BCBSMN products and systems strongly preferred.
• Call center experience and training helpful for this position.

Required Skills and Experiences:

• 4+ years of related experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Excellent time management skills.
• Demonstrated problem solving skills.
• Ability to effectively apply and demonstrate workflow instructions and successfully meet turn-around-time expectations.
• Strong systems and applications skills including data entry and MS Office Suite skills.
• Demonstrated data entry skills and attention to detail and accuracy.
• Strong interpersonal and verbal skills—ability de-escalate members verbally and maintain excellent customer service skills.
• Strong interpersonal and written communication skills; ability to express complex issues to individuals, groups, internal and external contacts, and write clear, concise and grammatically correct materials.
• Demonstrated organizational skills and levels of productivity that meet/exceed established benchmarks.
• Positive, professional, service oriented behavior.

Role Designation:

Teleworker

Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected].

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.