Description and Requirements
The Support Specialist is responsible for assisting the primary care/case managers (PCM/CM) with non-clinical activities such as providing telephonic outreaches to members for completion of service assessments, outreaches to providers and community-based organizations regarding service initiation and/or continuation, handling member mailings; faxing clinical requests and approved authorized service plans.
Duties and Responsibilities:
- Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requests
- Review intake documents for pre-approved services and escalate discrepancies as needed
- Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify any issues or risk factors that require clinical escalations to a CM/PCM.
- Initiate and finalize authorization in Trucare for preapproved services and DMEs and update and discontinue authorizations when applicable
- Handle and accurately document calls to and from members to assist with benefit questions/issues, schedule appointments, assessment inquiries, service issues and grievances
- Handle and accurately document calls to and from providers regarding authorizations initiation/updates, referrals, visits, tests, and faxed care plans
- Provide education to members and providers regarding requirements for approval of service requests
- Manage a large caseload while communicating member issues or needs and monitoring screening of members effectively to improve quality and cost outcomes
- Communicate with Inter/Intra-departments regarding reconciling onboarding issues
- Additional duties as assigned
Want more jobs like this?
Get Healthcare jobs that are Remote delivered to your inbox every week.
Minimum Qualifications:
- High School diploma or GED equivalent
- Experience in a customer service environment
- Experience working in a fast-paced environment that requires handling multiple priorities simultaneously
- Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills
Preferred Qualifications:
- Associate Degree/Certification in a related field
- Knowledge of medical terminology
- Knowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, Sharepoint
- Experience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management Department
- Experience with Microsoft Office Suite applications including Excel, Word, Outlook, and MS Teams
- English proficient bilingual who also speaks Spanish, Russian, Mandarin/Cantonese, French, Haitian Creole, Korean, Bengali, Punjabi, Hindi, or Urdu
- Demonstrated ability to document calls into a computer system
Regulatory or Compliance activities: n/a
License or Certification: n/a
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $39,208 - $52,000
- All Other Locations (within approved locations): $34,091 - $49,920
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.