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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
- Additional duties as assigned
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
- Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook
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. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
Know Your Rights
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
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.
