Duties and 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 interventionHandles calls to and from providers regarding authorizations, referrals, visits, tests, and faxed care plansManage requests from members, providers, call centers and care management teams regarding initial authorizations, authorization updates and/or correctionsComplete member and provider notification callsEscalates calls to appropriate departments which may include but is not limited to inbound/outbound calls on behalf of Care ManagersManages a large volume of tasks and caseloads from multiple queuesMeets/Exceeds all performance, quality and productivity measuresBuilds sustainable relationships of trust through open and interactive communication with internal and external customersDocuments accurate member information in compliance with our internal proceduresFollows established policies and procedures to ensure member and provider issues are addressed timely and accuratelyTimely communicates member issues or needs and monitors screening of members effectively to improve quality and cost outcomesComplies 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 guidelinesAdditional duties as assignedMinimum Qualifications:
High School diploma or GED from an accredited institutionPrior experience in a customer service environmentWorking experience in a fast-paced environmentProficient in Microsoft Office Suite applications including Excel, Word, and OutlookPreferred Qualifications:
Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese.Knowledge of medical terminologyExperience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management DepartmentExperience navigating multiple technologies including a Customer Relationship Management System (i.e., locate information, route future actions, notate resolutions, update member information, etc.)Proven track record of exercising independent thinking, problem solving and achieving goalsExcellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentationsHiring Range*:
Greater New York City Area (NY, NJ, CT residents): $39,208 - $52,000
All Other Locations (within approved locations): $34,091 - $49,920
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.