Exception Specialist

Modivcare•Phoenix, AZ

1d•$16 - $22•Onsite

About The Position

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. Will additionally, be involved in researching and resolving issues, monitoring phone activity for efficiency, and addressing trends indicative of abusive practices.

Requirements

High School Diploma required.
Two (2) 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

Facilitates various client-related procedures, including but not limited to 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 through digital, web-based, phone, and fax channels.
Documents in the Attendance Recovery Workbook to address attendance-related challenges.
Distributes mass transit information and resources for timely communication and coordination.
Evaluates and approves requests for excessive mileage, ensuring compliance and cost-effectiveness.
Facilitates the process of obtaining prior authorizations for transportation services.
Liaises with healthcare providers and insurance entities to secure necessary approvals.
Processes CMMNAs and/or LMN, ensuring compliance with established protocols.
Facilitates fair hearings and denial appeals, collaborating with stakeholders for smooth resolution.
Manages spend down activities, tracking and reporting expenditures per regulatory requirements.
Collects receipts and handle invoicing process for meals and lodging associated with transportation services.
Maintains a comprehensive facility rolodex with accurate contact information for healthcare facilities and service providers.
Monitors Westfax operations, promptly addressing issues and ensuring data integrity.
Suggests level of service downgrades, aligning transportation services with changing member needs.
Reviews previous day cancellations for standing order riders, implementing corrective actions.
Communicates trip updates promptly via email, LCAD system, or other channels for real-time information sharing.
Administers the provider liquidated damage process, including assessment, documentation, and resolution of claims related to service disruptions or contractual breaches.
Ensures accurate trip data input and resolution according to service guidelines.
Researches and resolves issues requiring further action, such as benefit utilization, verification, waivers, urgent trip requests, and process denials.
Observes and advises the management team on customer service and exceptions process.
Manages and oversees the department's inbound and outbound phone activity for quality and efficiency.
Investigates issues to confirm actual utilization, identify, and monitor utilization and billing trends signaling abusive practices.
Reports to management the need to address abusive or fraudulent situations.
May generate and issue Denial/RNS Letters for denied claims or non-serviced requests.
May lead 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!)