DSNP Support Specialist

Blue Cross & Blue Shield of Rhode Island•US Remote, RI

8d•$53,400 - $72,000•Hybrid

About The Position

The DSNP Support Specialist provides administrative and operational support to the D-SNP Case Management department by assisting with member communications, report management, data entry, document translation, scheduling, and departmental follow-up tasks. This role supports clinical staff, helps ensure accurate and confidential processing of member information, and contributes to timely completion of regulatory, operational, and service-related activities.

Requirements

High school degree
Two to four years experience in a medical, hospital, or third party payer setting.
Experience handling confidential member or patient information.
Experience using systems or databases to enter, track, and update information.
Experience prioritizing time-sensitive tasks and following established procedures.
Experience communicating with members, providers, vendors, or internal business partners.
Knowledge of medical terminology
Working knowledge of Microsoft Office including Excel, and Word
General computer proficiency
Strong Written and verbal communications skills
Good organization skills
Time management skills
Strong attention to detail and accuracy.
Ability to research and organize data
Ability to organize work efficiently to meet established time and quality standards.
Ability to manage multiple priorities and meet deadlines.
Ability to follow workflows, identify issues, and escalate appropriately.
Strong customer service and organizational skills.

Nice To Haves

Experience in a managed care environment
Knowledge of state and federal health regulations and accreditation standards (e.g., NCQA, URAC, DOH, DHS, CMS)
Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc
Experience with Medicare Advantage, D-SNP, Medicaid, or government programs.
Experience with MHK, similar systems, or other EMR systems.

Responsibilities

Respond to inquiries from internal and external customers; facilitate problem resolution through research. Refer call to appropriate resources in a timely manner.
Interact with clinical staff to obtain health care information necessary for data entry, or quality and team initiatives. Perform data entry into the medical information system and other applicable data bases.
Ensure adherence to regulatory, accreditation, and departmental standards.
Assist team with department initiatives and projects.
Run Daily/Weekly/monthly reports to support operational needs of the division and other duties as assigned to support corporate objectives.
Support the ICT Process by pulling Invite report, scheduling members and managing ICT calendar.
Support the DSNP Case Management document translation process by monitoring the translation inbox, submitting documents for translation, uploading translated documents into MHK and sending out to mail to members.
Provide administrative support for the D-SNP Case Management department, including report management, data entry, member correspondence, and timely follow-up on departmental tasks.
Ensure accurate, confidential processing and tracking of departmental data in alignment with workflows, regulatory requirements, and service standards.
Support fulfillment team as needed.
Perform other duties as assigned.