CareFirst Careers

Hospital Transition of Care Operations Specialist

Resp & Qualifications

PURPOSE:  Supports the Hospital Transitions of Care program by performing non-clinical, administrative functions:
1. Collaborates with the Hospital Transition of Care staff, assists internal/external customers/providers, and proactively assist with duties related to care coordination and quality of care. 
2. Assists the Hospital Transition of Care staff with solving problems/issues related to business requirements and productivity.
3. Cooperates and interacts with other business areas to advance the goals of the company and improve the quality of its service.

PRINCIPAL ACCOUNTABILITIES: Under the directions of Manager of Care Management, the essential duties and responsibilities include but are not limited to, the following: Primary accountabilities include, but are not limited to, the following:

1. Assists the Hospital Transition of Care program with daily facility workload and organization to include:

• Assigns cases to the HTC based on facility. HTC then makes the clinical decision regarding the level.
• Verifies benefits (checks for Medicare Primary or coordination of benefits) /eligibility (newborns added to the policy). Maintain Medicare Primary admissions until exhaust/discharge.
• Verifies Admissions
• Enters discharge dates into cases.
• Transitions cases with extended length of stay to appropriate care coordinator (for the level 2 cases).
• Requests clinical documents from hospitals for new admissions.
• Maintain the RightFax (labeling and sorting faxes).
• Creates authorizations

2. Communicates and interacts professionally to internal/external customers/providers regarding non-clinical inquiries or problem resolution.
• Builds and maintains a solid professional relationship with all of the targeted facilities and is proficient and knowledgeable about the model.
• Manages Physician Call Center

3. Responsible for assignments as delegated by Manager.
• Attends mandatory meetings. 
• Assists with other duties as determined by the Manager and HTCs in support of departmental goals and deliverables. 


Required Experience/Skills/Abilities: 
• 1-3 years of experience providing non-clinical administrative support in health care setting or in customer facing role within health payor organization.
• Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. The incumbent must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. The incumbent must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Must demonstrate excellent computer skills and knowledge of multiple software systems, such as Microsoft Word, Outlook, and Excel.
• Must demonstrate excellent oral and written communication skills, time management, and organizational management skills; as well as problem solving skills.
• Must be able to manage concurrent tasks and perform the duties of fellow Operations Specialists in their absence.
• Travel will be required in accordance with business needs as directed by the   Transitions of Care Program.

Preferred: Bachelor’s degree and two years’ experience in health care/managed care setting or previous work experience within CareFirst Medical Management.  A thorough understanding of at least two major BCBS products, services, and benefits.  Additionally, thorough knowledge of BCBS claims payment and service policies.


Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 4/24/2020

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.


The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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