Operations Specialist - Care Management and Member Services

Job Summary:

The Operations Specialist - ESH is responsible for the clerical, administrative, customer service and coordination activities to support Care Management and Member Services.

Essential Functions:

• Supports the provision of care plans, including ordering services for members (equipment and supplies, transportation, personal care, etc.), service intake from members, assisting Nurse Care Managers with member interactions, and authorizations processing.
• Answers incoming calls, makes outgoing calls as requested and/or review member care management survey results, identifying issues requiring follow up.
• Orders services and supplies, ensuring timely delivery.
• Provides back-up support to Member Services Representatives, including inbound and outbound call responsibility and other duties as needed to support Care Management and Member Services.
• Create a welcoming environment by acknowledging a patient’s, visitor’s and customer’s presence immediately and being courteous and respectful to all.
• Convey a positive attitude by being friendly, kind and interested in helping others, giving full attention to what the customer is saying and listening without interruption.
• Acknowledge the customer’s requests and concerns; Respond in a timely manner.
• Work closely with the Clinical Team.
• Ensure appropriate verification of documents.
• Ensure all applicable HIPAA and State requirements/regulations are adhered to at all times.
• Perform any other job related duties as requested.

Education and Experience:

• High School or GED required
• Bilingual (fluent in Spanish, Russian or Chinese) required
• Familiarity with the healthcare environment (Medicaid/Medicare) preferred
• Previous Medical billing/terminology experience preferred
• Prior field experience working with therapists/other licensed medical professionals preferred

Competencies, Knowledge and Skills:

• Fluency (speaking, reading, and writing) in multiple languages as determined by needs of business is required
• Knowledge of Medicare and Medicaid regulations
• Ability to utilize Microsoft Office Products
• Knowledge of all federal, state, local and regulatory agency requirements as related to the department and position
• Ability to integrate age specific requirements with individual developmental, mental, social and cultural needs when performing procedures for geriatric members
• Excellent verbal and written communication skills
• Ability to handle conflicts in a professional manner
• Professional phone etiquette
• Proper use of grammar
• Ability to work in a fast paced environment
• Adaptable to a constantly changing environment
• Attention to detail
• Ability to multitask
• Ability to work independently and with a team
• Critical thinking and listening skills
• Decision making and problem solving skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:

$41,200.00 - $66,000.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Hourly

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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