Care Coordination Specialist

Healthfirst; Connecticut; Hybrid; USD 35,000 - 55,000; Full time

Job summary

Healthfirst in Connecticut is seeking a Support Coordinator to assist care/case managers with non-clinical tasks such as creating cases, authorizations, and telephonic outreach to members and providers. The role covers member mailings, outreach, and coordination with care teams while maintaining PHI and complying with HIPAA regulations.

The position emphasizes high-quality customer service, efficient workflow, and collaboration with internal and external stakeholders in a fast-paced health plan

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
• 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

Time management

Communication

Microsoft Office

Education

High School diploma or GED

Tools

Microsoft Office

CRM system

Job description

Healthfirst in Connecticut is seeking a Support Coordinator to assist care/case managers with non-clinical tasks such as creating cases, authorizations, and telephonic outreach to members and providers. The role covers member mailings, outreach, and coordination with care teams while maintaining PHI and complying with HIPAA regulations.

The position emphasizes high-quality customer service, efficient workflow, and collaboration with internal and external stakeholders in a fast-paced health plan