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

• Can manage a caseload of 200+ cases

• Knowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, Sharepoint and Monday.com

• 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

• Demonstrated ability to document calls into a computer system

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): $40,200 - $54,570

• All Other Locations (within approved locations): $34,900 - $52,000

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.