Support Specialist Bilingual Spanish

HealthFirst•Remote - NY, CT

2d•$34,900 - $54,570

About The Position

The Support Coordinator 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 specific clinical team, such as Care Management, Utilization Management, or Behavioral Health, and may include additional departmental responsibilities. The position conducts onboarding outreach and assessments, handles member and provider calls, initiates and maintains authorizations, and communicates with internal departments to resolve onboarding issues. It manages a large caseload while documenting interactions and escalating clinical concerns when needed.

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 verbal and written communication, with good grammar, spelling, and punctuation skills.

Nice To Haves

Associate degree or certification in a related field.
English proficiency and bilingual Spanish-speaking ability.
Knowledge of medical terminology.
Knowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, and Sharepoint.
Experience in managed care or another 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.
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 (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, identifying issues or risk factors requiring clinical escalation to a CM/PCM.
Initiate and finalize authorizations in Trucare for pre-approved services and DMEs, and update or discontinue authorizations when applicable.
Handle and accurately document calls with members concerning benefit questions or issues, appointments, assessments, service issues, and grievances.
Handle and accurately document calls with providers concerning authorization initiation or 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.