Job Description

**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 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 + Manages a large volume of tasks and caseloads from multiple queues + 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 **Minimum Qualifications:** + High School diploma or GED from an accredited institution + Prior experience in a customer service environment + Working experience in a fast-paced environment **Preferred Qualifications:** + Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese. + Knowledge of medical terminology + Experience in managed care or other area of the healthcare industry working in a Call Center environment or Care//Case Management Department + Experience 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 goals + Excellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentations WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Job Tags

Work experience placement, Work at office, Local area,

Similar Jobs