Support Coordinator

US-NY-New York
Requisition ID
2017-15264
Department Name
Care Management - FIDA

Overview

Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area.   Our members are our North Star, and our mission is guided by their needs and preferences in ensuring a superior experience and access to the highest quality healthcare when and where they need it. Healthfirst’s commitment to quality and member satisfaction has helped us earn top ratings for HMO health plans in New York City. We know that employees shape our company and connect us to our communities, and we look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers: - Dream Big, Plan Wisely - Break Down the Walls - Think Critically, Speak Up, Deliver with Pride - Inspire Through Trust, Lead By Example - Be Unstoppable Position Summary:    The Support Coordinator is responsible for assisting the care/case managers with non-clinical activities such as creating cases and events; providing telephonic outreach to members, providers and community-based organizations; handling member mailings; faxing clinical requests and Individual Health Care Plans on behalf of the care/case managers. May also provide assistance to the specific clinical team they are assigned to within the Medical Management Department.   This is a paperless work environment requiring daily hands-on administration of multiple electronic Patient Health Information (PHI) databases and security requirement tools such as encryption. These systems include, but are not limited to, CCMS (CareEnhance Clinical Management Software), Sunguard Macess Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (using VPN), scanning and creating .pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word and Outlook).   Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status  or any other characteristic protected by law.

Responsibilities

Duties and Responsibilities:

  • Outreach calls to and from members regarding benefit questions/issues, scheduling appointments for preventive care, and screening assessments to identify risk factors requiring case management intervention. Outreach calls to and from providers regarding authorizations, visits, tests, and faxed care plans. Receives referrals from right fax and within the interdisciplinary care team. Documentation of accurate Members demographic information, and management of an average case load of 200 cases. Monitors triggers for case creation from multiple sources: such as HRA, RR, transition, community providers. Assist members to access website educational materials. Opening and electronically entering case data.
  • Works within the interdisciplinary care team to support timely communication of member issues or needs and monitors screening of members effectively to improve quality and cost outcomes. Participates in Quality Improvement Programs (QIPs) to enroll and introduce members in new programs. Coordinates communications with community providers to obtain clinical information such as the member's Care Plan and pathway milestones. Member outreach for HEDIS/STAR measures. Assesses calls and if necessary, refers to appropriate staff, both clinical and non-clinical, for further review.
  • Receive and process incoming correspondence (faxes) including discharge dates, requests for services and authorizations, and receipt of necessary clinical information to support Medical
  • Management decision-making within NY State and Federal (CMS) required time frames. This may include creation of new CCMS events, re-opening existing CCMS events, and making proper changes in fields within CCMS

Qualifications

Minimum Qualifications: 

  • High School diploma or GED.
  • Basic Microsoft Word and Excel skills are required.
  • Complete fluency in speaking Spanish or another second language.
  • At least 1 year of experience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management Department.
  • Demonstrated ability to document calls into a computer system.
  • Knowledge of medical terminology.

 

Telecommuter requirements: 

  • Direct Ethernet FIOS or Cable internet connection (wireless connection not permitted).
  • Locked file cabinet for secure storage of equipment and paperwork such as job aides (Employee’s expense).
  • This is a paperless environment so there is no printing when working virtually and for the security of patient health information (PHI).

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