Remote Operations Specialist - Must reside in New York

CareSource•New York, NY

1d•$41,200 - $66,000•Remote

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 as requested, and review member care management survey results, identifying 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 by being courteous, respectful, friendly, kind, and attentive to customers, acknowledging their requests and concerns, and responding in a timely manner. Close collaboration with the Clinical Team is essential, along with ensuring appropriate verification of documents and adherence to all applicable HIPAA and State requirements/regulations. Any other job-related duties as requested will also be performed.

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, and authorizations processing.
Answers incoming calls, makes outgoing calls as requested and/or review 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.