Department Specialist III

Element Care; Lynn (MA); On-site; USD 34,000 - 47,000; Full time

Benefits offered by this job

Health insurance

Vision insurance

Paid time off

Job summary

Element Care in Lynn, Massachusetts is seeking a Department Specialist III to support the SCO UM Department by creating and reviewing service authorizations for enrolled members. This is a full-time role, Monday–Friday 8:00 AM–4:00 PM with no nights, weekends, or holidays.

Responsibilities include quality review of authorizations, outreach for documentation, regulatory adherence, and acting as a subject matter expert for UM policies. Strong communication and organizational skills are essential.

Qualifications

• High school diploma or equivalent.
• 3–5 years administrative experience.
• Proficient in Microsoft Office and quick to learn proprietary software.
• Able to interact with all levels of personnel.
• Strong written and verbal communication.
• Knowledge of HIPAA policies and guidelines.
• Proof of Covid vaccine.

Responsibilities

• Review member service authorizations for quality.
• Outreach to internal/external partners for documentation.
• Prioritize work by service decision timeframes.
• Apply regulatory guidelines to determine eligibility.
• Follow protocols to ensure regulatory compliance.
• Manage centralized electronic record work queue.
• Serve as SME on UM department policies and procedures.
• Provide back-up support to other areas.
• Provide training to non-exempt personnel.
• Perform other duties as required.

Skills

Communication skills

Organizational skills

Problem solving

Team collaboration

Attention to detail

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

Department Specialist III

Element Care Lynn, Massachusetts, United States

About this position

Great Life work Balance position with excellent benefits! The UM Support Specialist is a well-organized, team player who supports the SCO UM Department by creating and reviewing service authorizations for enrolled members. This is a full-time position, Monday- Friday 8-4 position; no nights, weekends or holidays!

Responsibilities

• Perform quality review of member service authorizations.
• Perform outreach to internal and external partners to obtain outstanding documentation to prepare authorizations for clinical review.
• Prioritize work based upon Service Decision timeframes (Standard vs Expedited)
• Apply regulatory guidelines to determine member qualification for decisoning of authorizations.
• Follow established protocols and compliance standards to ensure regulatory requirements are met.
• Manage Centralized Electronic Record work queue for authorization assignment.
• Serves as Subject Matter Expert concerning the UM department’s policies and procedures.
• Insupervisors’absence,ensuresthatalldepartmentalmattersarehandledappropriately.
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Required to complete annual Inter-Rater Reliability testing to decision member authorizations.
• Provideback-upsupporttootherareas.
• Providetrainingtoothernon-exemptpersonnel.
• Performs other duties as required.

Qualifications

• High school diploma or equivalent.
• Previous (3-5 years) administrative or related experience required.
• Must be able to resolve issues, collaborate with a team, and understand the need for accurate and timely communication and escalation.
• Working knowledge of, or proficient in, Microsoft office applications, and quick-to-learn proprietary software packages.
• Ability to interact with all levels of internal and external personnel.
• Strong written and verbal communication skills.
• Strong organizational skills, with attention to detail.
• Practice knowledge of HIPAA policies and guidelines.
• Proof of Covid vaccine
• Health insurance
• Vision insurance
• Paid time off

EEO Statement

Element Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.

Element Care is committed to valuing diversity and contributing to an inclusive working environment.

Salary Information

$24.52 - $34.13Hourly Wage