Care Coordination & Enrollment Specialist

Pride Health; New York (NY); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Healthcare coverage

Supplemental coverage

401(k) plan

Life & disability insurance

Employee assistance program

Legal support

Auto insurance

Home insurance

Pet insurance

Employee discounts

Job summary

Pride Health in New York, NY seeks a frontline member services specialist to support MLTC/MAP/PCS programs and ensure smooth member interactions.

You will handle incoming and outgoing calls, schedule medical visits, maintain member records, and coordinate with hospitals and vendors regarding benefits and services. Strong communication is essential.

Required: one year of direct customer contact; knowledge of medical terminology is preferred; prior call center experience is a plus.

Qualifications

• High School diploma or GED.
• 1 year of full-time direct consumer contact experience.
• Understanding of medical terminology preferred.
• ICD-10 and CPT-4 knowledge preferred.
• Prior managed care experience preferred.
• Prior customer services/call center experience required.

Responsibilities

• Handle incoming and outgoing calls for MLTC/MAP/PCS member support.
• Schedule appointments for Care Management staff and assist members with scheduling medical visits.
• Maintain member files and track membership status, admissions, ER visits, nursing home stays, and short-term absences.
• Serve as liaison between hospitals and HHA/PCS/CDPAS vendors regarding member benefits and services.
• Enter prior approvals and service authorizations into authorization systems and monitor queues for timely processing.
• Track required member documentation for authorization and re-authorization of Personal Care Services.
• Notify vendors of service start/end dates or cancellations and report trends to the Care Manager/Supervisor.

Skills

Customer service

Call center

Medical terminology

ICD-10/CPT-4 knowledge

Managed care

Direct member contact

Education

HS diploma or GED

Job description

Pride Health in New York, NY seeks a frontline member services specialist to support MLTC/MAP/PCS programs and ensure smooth member interactions.

You will handle incoming and outgoing calls, schedule medical visits, maintain member records, and coordinate with hospitals and vendors regarding benefits and services. Strong communication is essential.

Required: one year of direct customer contact; knowledge of medical terminology is preferred; prior call center experience is a plus.