Support Specialist-1

HealthFirst•Remote - NY, CT

20h•$34,900 - $54,570

About The Position

The Support Specialist assists primary care/case managers (PCM/CM) with non-clinical activities. The role includes contacting members to complete service assessments; contacting providers and community-based organizations about starting or continuing services; handling member mailings; and faxing clinical requests and approved authorized service plans. The Specialist supports member onboarding and service authorization workflows, documents calls, responds to benefit and service questions, and escalates issues or risk factors to clinical staff when appropriate. The position also manages a large caseload and coordinates with internal departments to resolve onboarding issues.

Requirements

High school diploma or GED equivalent.
Experience in a customer service environment.
Experience working in a fast-paced environment requiring the handling 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 proficiency and bilingual ability in Spanish or Mandarin/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, working in a call center environment or a Care/Case Management Department.
Experience with Microsoft Office Suite applications, including Excel, Word, Outlook, and MS Teams.
Demonstrated ability to document calls into a computer system.

Responsibilities

Conduct outreaches 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 that require clinical escalation to a CM/PCM.
Initiate and finalize authorizations in Trucare for pre-approved services and DMEs; update or discontinue authorizations when applicable.
Handle and accurately document calls with members about benefit questions or issues, appointments, assessment inquiries, 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.