Hybrid Operations Specialist - Rehab - Russian Speaking preferred
About The Position
The Operations Specialist - ESH is responsible for the clerical, administrative, customer service and coordination activities to support Care Management and Member Services. This role supports the provision of care plans, including ordering services for members (equipment and supplies, transportation, personal care, etc.), service intake from members, assisting Nurse Care Managers with member interactions, and authorizations processing. The specialist will answer incoming calls, make outgoing calls, review member care management survey results, and identify issues requiring follow-up. They will order services and supplies, ensuring timely delivery, and provide back-up support to Member Services Representatives. The role requires creating a welcoming and positive environment, working closely with the Clinical Team, ensuring document verification, and adhering to HIPAA and State requirements.
Requirements
- High School or GED required
- Bilingual (fluent in Spanish, Russian or Chinese) required
- Fluency (speaking, reading, and writing) in multiple languages as determined by needs of business is required
- Knowledge of Medicare and Medicaid regulations
- Ability to utilize Microsoft Office Products
- Knowledge of all federal, state, local and regulatory agency requirements as related to the department and position
- Ability to integrate age specific requirements with individual developmental, mental, social and cultural needs when performing procedures for geriatric members
- Excellent verbal and written communication skills
- Ability to handle conflicts in a professional manner
- Professional phone etiquette
- Proper use of grammar
- Ability to work in a fast paced environment
- Adaptable to a constantly changing environment
- Attention to detail
- Ability to multitask
- Ability to work independently and with a team
- Critical thinking and listening skills
- Decision making and problem solving skills
Nice To Haves
- Familiarity with the healthcare environment (Medicaid/Medicare) preferred
- Previous Medical billing/terminology experience preferred
- Prior field experience working with therapists/other licensed medical professionals preferred
Responsibilities
- Supports the provision of care plans, including ordering services for members (equipment and supplies, transportation, personal care, etc.)
- Service intake from members
- Assisting Nurse Care Managers with member interactions
- Authorizations processing
- Answers incoming calls and makes outgoing calls as requested
- Reviews member care management survey results, identifying issues requiring follow up
- Orders services and supplies, ensuring timely delivery
- Provides back-up support to Member Services Representatives, including inbound and outbound call responsibility and other duties as needed to support Care Management and Member Services
- Create a welcoming environment by acknowledging a patient’s, visitor’s and customer’s presence immediately and being courteous and respectful to all
- Convey a positive attitude by being friendly, kind and interested in helping others, giving full attention to what the customer is saying and listening without interruption
- Acknowledge the customer’s requests and concerns; Respond in a timely manner
- Work closely with the Clinical Team
- Ensure appropriate verification of documents
- Ensure all applicable HIPAA and State requirements/regulations are adhered to at all times
- Perform any other job related duties as requested
Benefits
- Substantial and comprehensive total rewards package
- May qualify for a bonus tied to company and individual performance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
