Support Specialist
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Job Description
Support Specialist managing non-clinical activities like outreach and documentation for primary care/case managers. Engaging with members and providers in a customer service capacity.
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.
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
- Associate Degree/Certification in a related field preferred
- 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.
Benefits:
- medical, dental and vision coverage
- incentive and recognition programs
- life insurance
- 401k contributions (all benefits are subject to eligibility requirements)
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