Support Specialist-1

HealthFirst

21h•Hybrid

About The Position

The Support Specialist is responsible for assisting the primary care/case managers (PCM/CM) with non-clinical activities such as providing telephonic outreaches to members for completion of service assessments, outreaches to providers and community-based organizations regarding service initiation and/or continuation, handling member mailings; faxing clinical requests and approved authorized service plans.

Requirements

High School diploma or GED equivalent
Experience in a customer service environment
Experience working in a fast-paced environment that requires handling multiple priorities simultaneously
Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills

Nice To Haves

Associate Degree/Certification in a related field
Knowledge of medical terminology
Knowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, Sharepoint
Experience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management Department
Experience with Microsoft Office Suite applications including Excel, Word, Outlook, and MS Teams
English proficient bilingual who also speaks Spanish, Russian, Mandarin/Cantonese, French, Haitian Creole, Korean, Bengali, Punjabi, Hindi, or Urdu
Demonstrated ability to document calls into a computer system

Responsibilities

Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requests
Review intake documents for pre-approved services and escalate discrepancies as needed
Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify any issues or risk factors that require clinical escalations to a CM/PCM.
Initiate and finalize authorization in Trucare for preapproved services and DMEs and update and discontinue authorizations when applicable
Handle and accurately document calls to and from members to assist with benefit questions/issues, schedule appointments, assessment inquiries, service issues and grievances
Handle and accurately document calls to and from providers regarding authorizations initiation/updates, referrals, visits, tests, and faxed care plans
Provide education to members and providers regarding requirements for approval of service requests
Manage a large caseload while communicating member issues or needs and monitoring screening of members effectively to improve quality and cost outcomes
Communicate with Inter/Intra-departments regarding reconciling onboarding issues
Additional duties as assigned