• Job Description

  Req#: JR-911698

  Your Future Evolves Here

  Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

  Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

  Join Evolent for the mission. Stay for the culture.

  What You’ll Be Doing:

  We believe in the power of partnerships to help people navigate their care with less friction, frustration, and fear. And that every person deserves the same level of case and compassion we would want for our loved ones.

  We also believe that trust must be earned every day, in every interaction, through productive, collaborative relationships with physicians and payers, and that nothing builds trust like delivering better health outcomes.

  Collaboration Opportunities:

  Joining the Operations Team would provide the candidate with the stability, knowledge, and ability to help not only our external customers but internal customers as well by providing superior service and support. Our team focuses on collaboration, a team-oriented environment, as well as continual learning to have a better understanding of the company as a whole and will offer as provide opportunities for continual growth.

  What you will be doing:

  • Prioritizes incoming prior-authorization and pre-certification requests as outlined in departmental policies, procedures, and workflow guidelines.
  • Contacts the health plan to gain plan information, verify active coverage, obtain all plan benefits as well as authorization requirements.
  • Communicates efficiently and professionally directly with facility or Account Management team to acquire all necessary documentation for case decisioning as well as provides this information to the health plans to ensure all requirements are met for authorization.
  • Follows up timely and within department guidelines on all cases that are pending information and escalates cases as necessary if help is needed to obtain documentation.
  • Receives inbound and makes outbound calls to healthcare professionals, commercial and workers’ comp carriers, and manufacturer sales representatives.
  • Makes accurate, appropriate and timely case notes and database entries to ensure accurate and detailed case information.
  • Refers requests that require clinical judgment to Underwriter Supervisor.
  • Meets position metrics and turn-around timeframes using reports provided while maintaining a full caseload.
  • Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

  Qualifications:

  Excellent customer service - 6 months or more of customer service/Case Management experience- REQUIRED

  College degree – PREFERRED

  Authorization/Insurance experience - PREFERRED

  Fluent with all Microsoft Office applications – REQUIRED

  Strong self-starter and problem solver – REQUIRED

  Must be able to quickly build a productive relationship with individuals and departments – REQUIRED

  Must be able to work individually in a fast paced, high-volume environment – REQUIRED

  Fluent in medical terminology - PREFERRED

  Technical Requirements:

  We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

  Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

  The expected base salary/wage range for this position is $26/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

• About the company

  Evolent partners with payers and providers to dramatically reduce the total cost of care, improve clinical quality and simplify administration.

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