Exception Specialist III

Modivcare•Charleston, WV

1d•$16 - $22

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 experienced Exception Specialist III to join our team. This position is responsible for facilitating various client procedures, managing standing orders, and coordinating transportation services. This role involves addressing attendance challenges, distributing mass transit information, and evaluating mileage requests for compliance and cost-effectiveness. It also includes researching and resolving issues, monitoring phone activity for efficiency, and identifying trends indicative of abusive practices.

Requirements

High School Diploma required.
Two (2) plus years of relevant experience. Or equivalent combination of education and/or experience.
Excellent customer service and interpersonal skills.
Ability to work both independently and as part of a team.
Quick to learn new technologies and processes.
Strong ability to follow complex instructions and resolve issues.
Proficient in written and spoken English.
Exceptional attention to detail and accuracy.
Skilled in managing multiple tasks while maintaining service quality.

Responsibilities

Facilitates various client-related procedures including Minor Consent Forms, Attendant Forms, Plan of Care documents, and Trip Limits. Ensures accuracy and compliance with established protocols and regulatory requirements.
Creates, modifies, and recertifies standing orders via digital, web-based, phone, and fax channels.
Documents attendance challenges using the Attendance Recovery Workbook.
Distributes mass transit information and resources for effective communication.
Evaluates and approves excessive mileage requests for compliance and cost-efficiency.
Secures prior authorizations for transportation services by coordinating with healthcare providers and insurance entities.
Processes CMMNAs and/or LMN requests in accordance with procedural requirements.
Coordinates fair hearings and denial appeals, collaborating with stakeholders to resolve issues efficiently.
Manages spend-down activities including expenditure tracking and reporting.
Collects receipts and handles invoicing for meals and lodging related to transportation services.
Maintains a comprehensive facility rolodex with up-to-date contact information for healthcare facilities and service providers.
Monitors Westfax operations and ensures prompt issue resolution and data integrity.
Recommends downgrades in level of service to reflect members' changing needs.
Reviews cancellations for standing order riders and implements corrective actions.
Communicates trip updates via email, LCAD system, or other tools in real-time.
Administers the provider liquidated damage process, including documentation and resolution of claims related to service disruptions or contract breaches.
Ensures trip data is accurately entered and resolved according to service guidelines.
Researches and resolves issues related to benefit utilization, eligibility verification, waivers, urgent trip requests, and denial processes.
Advises management on customer service and exceptions processing.
Oversees inbound and outbound phone activity for quality and operational efficiency.
Investigates utilization and billing patterns to detect and report abusive practices.
May generate and issue Denial/RNS letters for non-serviced requests or denied claims.
May lead special projects and perform other 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!)