Exception Specialist II

Modivcare•Charleston, WV

18d•$14 - $19

About The Position

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an Exception Specialist II to join our team! This position is responsible for the accurate fulfillment and approval procedures related to transportation service requests/reservations before and/or after the transport has taken place, through the use of internal and external resources as well as outreaching to members, facilities, clients, and other parties. This role... Ensures accurate trip data input and resolution as it relates to the service guidelines. Identifies and advises management team on issues relating to customer service and the exceptions process. Investigates and provides comprehensive solutions on benefit utilization issues, verification, waivers, urgent trip requests, pre-authorization, process denials, eligibility, mileage validation, meals & lodging, and level of service. Manages and suggests improvements in the denial and appeal process. Assists other specialists in faxes, mail, email, and web requests (inbound and outbound). Suggests improvement of quality and efficiency with the department's phone activity (inbound and outbound). Investigates complex issues to confirm the utilization. Identifies and monitors utilization and billing trends that may signal abusive practices. Reports and may provide support to management on the need to address abusive or fraudulent situations. Reports member dissatisfaction to appropriate team members and/or management. Provides outreach regarding members, transportation, education, and other subjects as needed to medical facilities. Support specialists by providing guidance and knowledge sharing to improve skills and department efficiencies. Participates in other projects or duties as assigned.

Requirements

High School Diploma required.
One (1) plus years of experience. Or equivalent combination of education and/or experience.
Excellent customer service and people skills.
Works independently or with a team.
Quickly learns new technology and processes.
Understands and follows complex instructions; handle complex issues.
Proficient in writing, reading, and fluency in speaking English.
Accurate and attention to detail.
Ability to handle multiple tasks without compromising the quality of service.

Responsibilities

Ensures accurate trip data input and resolution as it relates to the service guidelines.
Identifies and advises management team on issues relating to customer service and the exceptions process.
Investigates and provides comprehensive solutions on benefit utilization issues, verification, waivers, urgent trip requests, pre-authorization, process denials, eligibility, mileage validation, meals & lodging, and level of service.
Manages and suggests improvements in the denial and appeal process.
Assists other specialists in faxes, mail, email, and web requests (inbound and outbound).
Suggests improvement of quality and efficiency with the department's phone activity (inbound and outbound).
Investigates complex issues to confirm the utilization.
Identifies and monitors utilization and billing trends that may signal abusive practices.
Reports and may provide support to management on the need to address abusive or fraudulent situations.
Reports member dissatisfaction to appropriate team members and/or management.
Provides outreach regarding members, transportation, education, and other subjects as needed to medical facilities.
Support specialists by providing guidance and knowledge sharing to improve skills and department efficiencies.
Participates in other projects or duties as assigned.

Benefits

Medical, Dental, and Vision insurance
Employer Paid Basic Life Insurance and AD&D
Voluntary Life Insurance (Employee/Spouse/Child)
Health Care and Dependent Care Flexible Spending Accounts
Pre-Tax and Post --Tax Commuter and Parking Benefits
401(k) Retirement Savings Plan with Company Match
Paid Time Off
Paid Parental Leave
Short-Term and Long-Term Disability
Tuition Reimbursement
Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)