Healthfirst New York Jobs

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 escalate 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

• 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

• English proficient bilingual who also speaks Spanish, Russian, Mandarin/Cantonese, French, Haitian Creole, Korean, Bengali, Punjabi, Hindi, or Urdu

• Demonstrated ability to document calls into a computer system

Regulatory or Compliance activities: n/a

License or Certification: n/a

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.