Authorization & Care Coordination Specialist

Healthfirst; Town of Florida (NY); On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401k contributions

Job summary

Healthfirst in New York seeks a Support Coordinator to assist care/case managers with non-clinical duties such as creating cases, authorizations, and outreach to members, providers, and community organizations.

The role requires handling member communications, documenting information per internal procedures, and supporting several care teams while meeting performance and quality measures. HIPAA confidentiality is essential.

Qualifications

• High School diploma or GED from an accredited institution.
• Prior experience in a customer service environment.
• Working experience in a fast-paced environment.
• Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook.

Responsibilities

• Provides excellent quality customer service to our members and/or providers relating to authorization updates, questions/issues such as coordinating care, DME outreach, scheduling appointments, and screen assessments to identify risk factors which need closer intervention
• Handles calls to and from providers regarding authorizations, referrals, visits, tests, and faxed care plans
• Manage requests from members, providers, call centers and care management teams regarding initial authorizations, authorization updates and/or corrections
• Complete member and provider notification calls
• Escalates calls to appropriate departments which may include but is not limited to inbound/outbound calls on behalf of Care Managers
• Manages a large volume of tasks and caseloads from multiple queues
• Meets/Exceeds all performance, quality and productivity measures
• Builds sustainable relationships of trust through open and interactive communication with internal and external customers
• Documents accurate member information in compliance with our internal procedures
• Follows established policies and procedures to ensure member and provider issues are addressed timely and accurately
• Timely communicates member issues or needs and monitors screening of members effectively to improve quality and cost outcomes
• Complies with HIPAA requirements and maintains Protected Health Information (PHI) confidentiality of member, provider, medical and departmental information, and adheres to local, state, federal and Healthfirst specific compliance and regulatory guidelines
• Additional duties as assigned

Skills

Customer service

Communication

Multitasking

Phone support

Education

High School diploma or GED

Tools

Microsoft Office

Excel

Word

Outlook

CRM system

Job description

Healthfirst in New York seeks a Support Coordinator to assist care/case managers with non-clinical duties such as creating cases, authorizations, and outreach to members, providers, and community organizations.

The role requires handling member communications, documenting information per internal procedures, and supporting several care teams while meeting performance and quality measures. HIPAA confidentiality is essential.