Operations Specialist (Hybrid/Brooklyn, NY)

CareSource Management Services•Brooklyn, NY

2d•Hybrid

About The Position

The Operations Specialist - ESH supports Care Management and Member Services through clerical, administrative, customer service, and coordination activities. The role supports care plans by arranging member services and supplies, handling service intake, assisting Nurse Care Managers with member interactions, and processing authorizations. It also provides phone support and backup for Member Services Representatives and works closely with the Clinical Team. The position is based in a general office environment, where extended periods of sitting or standing may be required; travel is not typically required. The specialist is expected to create a welcoming, respectful environment for patients, visitors, and customers; listen attentively and respond to requests and concerns in a timely manner; and verify documents appropriately. The role must comply with applicable HIPAA, state, and other regulatory requirements. Other job-related duties may be assigned. The compensation range is $41,200 to $66,000, hourly, with possible eligibility for a performance-related bonus and a comprehensive total rewards package.

Requirements

High school diploma or GED.
Fluency in Spanish, Russian, or Chinese is required; fluency includes speaking, reading, and writing in multiple languages as determined by business needs.
Knowledge of Medicare and Medicaid regulations.
Ability to use Microsoft Office products.
Knowledge of federal, state, local, and regulatory agency requirements 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 professionally and demonstrate proper phone etiquette and grammar.
Ability to work in a fast-paced, constantly changing environment.
Attention to detail and ability to multitask.
Ability to work independently and as part of a team.
Critical thinking, listening, decision-making, and problem-solving skills.

Nice To Haves

Familiarity with the healthcare environment, including Medicaid and Medicare.
Previous medical billing or medical terminology experience.
Prior field experience working with therapists or other licensed medical professionals.

Responsibilities

Support care plans, including ordering member services, equipment, and supplies; handling service intake; assisting Nurse Care Managers with member interactions; and processing authorizations.
Answer incoming calls and make outgoing calls as requested; review member care management survey results and identify issues requiring follow-up.
Order services and supplies and ensure timely delivery.
Provide backup support to Member Services Representatives, including inbound and outbound calls and other duties needed to support Care Management and Member Services.
Create a welcoming environment and interact with patients, visitors, and customers courteously and respectfully.
Listen attentively to customers, acknowledge their requests and concerns, and respond in a timely manner.
Work closely with the Clinical Team.
Ensure appropriate verification of documents.
Adhere to applicable HIPAA and state requirements and regulations.
Perform other job-related duties as requested.