Support Specialist-1

Healthfirst; United States; On-site; USD 35,000 - 55,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401k contributions

Incentive programs

Job summary

Healthfirst is seeking a Support Specialist to assist primary care/case managers with non-clinical tasks, including member outreach, provider communications, and processing service requests. Responsibilities include reviewing intake documents, initiating authorizations in Trucare, documenting calls, educating members and providers, and coordinating with other departments to resolve onboarding issues.

Minimum qualifications: high school diploma or GED and customer service experience; preferred:

Qualifications

• High School diploma or GED equivalent.
• Experience in a customer service environment.
• Experience in fast-paced environment handling multiple priorities.
• Strong verbal and written communication skills.

Responsibilities

• Outreach to new enrollees to review services and requests.
• Review intake documents for pre-approved services and escalate discrepancies.
• Complete onboarding assessments and identify issues needing clinical escalation.
• Initiate and finalize authorizations in Trucare for preapproved services and DMEs.
• Document calls to assist with benefits, appointments, inquiries, issues, and grievances.
• Document calls with providers regarding authorizations, referrals, visits, tests, and care plans.
• Educate members and providers on service approvals requirements.
• Manage a large caseload and coordinate with departments to improve outcomes.

Skills

Customer service

Multitasking

Communication skills

Bilingual English/Spanish

Education

High School Diploma

GED equivalent

Tools

Trucare

Salesforce

HHAXchange

DocuSign Espaces

SharePoint

Microsoft Office

MS Teams

Job description

The Support Specialist is responsible for assisting the primary care/case managers (PCM/CM) with non-clinical activities such as providing telephonic outreaches to members for completion of service assessments, outreaches to providers and community-based organizations regarding service initiation and/or continuation, handling member mailings; faxing clinical requests and approved authorized service plans.

Duties And 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 elevate 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

Minimum Qualifications

• 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

Preferred Qualifications

• Associate Degree/Certification in a related field
• English proficient bilingual who also speaks Spanish or Mandarin/Cantonese.
• 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
• Demonstrated ability to document calls into a computer system

Hiring Range*

• Greater New York City Area (NY, NJ, CT residents): $40,200 - $54,570
• All Other Locations (within approved locations): $34,900 - $52,000

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.