Description and Requirements 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 requestsReview intake documents for pre-approved services and escalate discrepancies as neededComplete 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 applicableHandle and accurately document calls to and from members to assist with benefit questions/issues, schedule appointments, assessment inquiries, service issues and grievancesHandle and accurately document calls to and from providers regarding authorizations initiation/updates, referrals, visits, tests, and faxed care plansProvide education to members and providers regarding requirements for approval of service requestsManage a large caseload while communicating member issues or needs and monitoring screening of members effectively to improve quality and cost outcomesCommunicate with Inter/Intra-departments regarding reconciling onboarding issuesAdditional duties as assigned

Minimum Qualifications: 

High School diploma or GED equivalentExperience in a customer service environmentExperience working in a fast-paced environment that requires handling multiple priorities simultaneouslyWork experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills

Preferred Qualifications: 

Associate Degree/Certification in a related fieldKnowledge of medical terminologyKnowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, SharepointExperience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management DepartmentExperience with Microsoft Office Suite applications including Excel, Word, Outlook, and MS TeamsEnglish proficient bilingual who also speaks Spanish, Russian, Mandarin/Cantonese, French, Haitian Creole, Korean, Bengali, Punjabi, Hindi, or UrduDemonstrated ability to document calls into a computer system

Regulatory or Compliance activities: n/a

License or Certification: n/a

Hiring 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.