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
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
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $38,200 - $49,920
All Other Locations (within approved locations): $33,300 - $47,840
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