Support Specialist Bilingual Mandarin Cantonese

HealthFirst•Remote - NY, CT

1d•$34,900 - $54,570

About The Position

The Support Specialist assists care and case managers with non-clinical activities, including creating cases and events, conducting telephonic outreach to members, providers, and community-based organizations, handling member mailings, and faxing clinical requests and Individual Health Care Plans on behalf of care and case managers. The role is assigned to a clinical team, such as Care Management, Utilization Management, or Behavioral Health, and may have additional departmental responsibilities. The position conducts onboarding and service-related outreach, reviews intake documents, processes authorizations for preapproved services and durable medical equipment, and responds to member and provider inquiries. It documents calls and coordinates with other departments to address onboarding issues while managing a large caseload. The role also provides education about service-request approval requirements and escalates clinical concerns to care management staff as needed.

Requirements

High school diploma or GED equivalent.
Experience in a customer service environment.
Experience working in a fast-paced environment requiring management of multiple priorities simultaneously.
Work experience requiring effective verbal and written communication, including good grammar, spelling, and punctuation skills.

Nice To Haves

Associate degree or certification in a related field.
English-proficient bilingual ability, including Mandarin and/or Cantonese.
Knowledge of medical terminology.
Knowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, and SharePoint.
Experience in managed care or another area of the healthcare industry, in a call center environment or Care/Case Management Department.
Experience with Microsoft Office Suite applications, including Excel, Word, Outlook, and MS Teams.
Demonstrated ability to document calls in a computer system.

Responsibilities

Conduct outreach to newly enrolled members to review current and approved services, durable medical equipment, and additional requests.
Review intake documents for pre-approved services and escalate discrepancies as needed.
Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments, identifying issues or risk factors that require clinical escalation to a CM/PCM.
Initiate and finalize authorizations in Trucare for preapproved services and durable medical equipment; update or discontinue authorizations when applicable.
Handle and accurately document calls with members about benefit questions and issues, appointments, assessments, service issues, and grievances.
Handle and accurately document calls with providers regarding authorization initiation and updates, referrals, visits, tests, and faxed care plans.
Educate members and providers about requirements for approval of service requests.
Manage a large caseload, communicate member issues or needs, and monitor member screening to improve quality and cost outcomes.
Communicate with inter- and intra-departments to reconcile onboarding issues.
Perform additional duties as assigned.