Medical Services Support Specialist I (Shared Services) - 007665 - Univera Healthcare : Job Details

** Medical Services Support Specialist I (Shared Services) - 007665**

**Job Category****:** Non Manager **Requisition Number****:** MEDIC007376 Showing 1 location **Job Details**

**Description**

**PLEASE NOTE: With limited exceptions, our company is requiring all employees to be vaccinated against COVID-19 by Jan. 1, 2022. We also currently mandate vaccinations for employees who enter our buildings. Please keep this in mind when applying for positions at our organization.**

The Medical Services Support Representative supports the workflow of the Medical Service (Medical and Behavioral Health) UM& CM departments as well as the pharmacy department. The Representative is focused on total customer satisfaction and as such is empowered to facilitate various inbound and outbound calls and tasks on behalf of the member(s) of Health Plan. The incumbent is responsible for timely and accurate inbound and outbound call processes, documentation and on-line reporting of the calls as well as responding to internal/external customers, regardless of the issue or the customers demeanor and demonstrates flexibility in meeting the customers needs. As an integral part of the Medical Service team, the position serves as the subject matter expert for the department and provides exceptional service that builds customer satisfaction.

Essential Responsibilities/Accountabilities

All Levels

Accesses on-line patient information (HIPAA) and management systems so as to facilitate inbound and outbound calls to customers by maintaining high regard for member privacy in accordance with corporate privacy policies and procedures.

Triages appropriate follow-up actions resulting from customer inquiries; ensures problems are resolved to the customers satisfaction within the required timeframe.

Contacts members concerning regulatory requirements relating to Department of Health (DOH) notifications and other legislative requirements (NCQA).

Provides assistance to the patient(s) in resolving various inquires.

Identifies potential Member and Disease Management opportunities to determine member(s) interest in our program(s).

Educates members, when appropriate on the various Member and Disease Management programs.

Serves as point of contact for problems stemming from Medical Services clinical documentation systems.

Identifies and suggests solutions to system limitations so as to enhance various support functions.

Participates in the trainings needed to learn regulations, claims systems, develop skills, and initiate actions to accurately fulfill all requirements of the job.

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies mission and values and adhering to the Corporate Code of Conduct.

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

Regular and reliable attendance is expected and required.

Performs other functions as assigned by management.

Level ll performs similar responsibilities as level l in addition to the following:

Duties performed under limited supervision.

Accesses on-line patient information and management systems so as to facilitate inbound calls with customers.

Accesses claim and patient information through iFacets to respond to members inquiries.

Triages-linking end-users with business analysts, operations and training areas, and I/T and other departments, as appropriate.

Performs intake assessment and triages functions to the appropriate team member.

Creates Member and Disease Management referrals.

Prepares and assists in handling member and provider correspondence related to authorization detail, disease conditions and/or care management program services. Assures accuracy and timeliness of processing.

Level III - performs similar responsibilities as level I and II in addition to the following:

Successful Completion and proven proficiency of skills as defined in level I and II

Assists the Team Lead/Supervisor with assigned tasks when necessary

Initiates involvement for higher level responsibilities or proactively volunteers for assisting in the resolution of escalated or systemic issues.

Participates in system testing and provides input on program development and implementation strategy, from a user perspective, on an ongoing basis.

Minimum Qualifications

Note of Classification

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

LPN, Medical Assistant, Health Plan customer service or claims processor experience with a minimum of one year experience working in an insurance company or medical care setting required.

Minimum of one year of customer service experience preferred; preferably in a call center environment.

Knowledge of Federal/State regulations and requirements.

Working knowledge of medical terminology and the claims systems required.

Must possess operational and insurance knowledge.

Demonstrates proficiency in basic navigation and utilization of department specific applications: care management system, department libraries.

Excellent oral and written communication skills.

Ability to multi-task in order to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously.

Demonstrates role-specific competencies as it pertains to individual work unit on a consistent basis.

Excellent computer skills required, including the ability to navigate in a Windows environment, Lotus Notes understanding preferred and instant messaging and text message technology used regularly.

Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under pressures and demands.

Attention to detail.

Ability to work effectively as a member of a team.

Level ll requires similar qualifications as level l, plus:

Minimum of 1 years experience with both inbound and outbound calls.

Strong organizational skills and ability to prioritize, multitask and work in fast pace environment.

Working knowledge of all Member and Disease Management programs.

Ability to triage calls.

Resolves customer inquiries across multiple lines of business.

Demonstrated proficiency navigating in a Windows environment.

Advanced skill working between multiple programs and applications simultaneously.

Level llI requires similar qualifications as level l and II, plus:

Minimum of 2 years experience with both inbound and outbound calls.

Ability to resolve customer inquiries across multiple plans with limited assistance.

Able to identify potential systematic issues and report as necessary without Team Lead/ Supervisor assistance.

Physical Requirements

Must possess the ability to sit for long periods and view information on computer monitor

Some travel may be required

Some work evenings or weekends may be required

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to p