Support coordinators in this role use their analytical experience and critical thinking skills to manage highly variable situations related to the processing of authorization requests, management of incoming documentation, management of incoming electronic health information exchange (HIE) information, and member and provider outreach. They collaborate with multiple departments to troubleshoot any documentation issues that may arise with either the receipt or processing of documentation. They support the team leaders in collaboration with downstream dependents to ensure an effective and efficient transition of authorization information. Additionally, they support the receipt, logging and creating of files for the RightFax and HIE team.

Responsibilities:

• E l ectroni c logging of documentation and subsequent notification to downstream entities including Utilization Management (UM), Care Management (CM) or other teams. Ensure that the i nput i nformation is correct and complete , including member/provider information, medical records, and P rotected Health Information (PHI ).

• D ata entry of authorization requests including location of services, medical diagnoses, and service codes ; T elephonic outreach to providers or collaboration with UM Management required in some instances to confirm provider request information .

• T elephonic support to the UM team with the process of member and provider notification of both favorable and adverse determinations for authorizations created within the RightFax depar t ment .  

• Electronic logging of all critical incoming fax documentation to ensure regulatory compliance adherence. These include, but are not limited to, expedited authorization requests, pharmacy requests, skilled nursing facility requests, homecare requests, and any other documentation with stringent regulatory time frames.

• C ross departmental c ollaboration to investigate and solve op erational issues as well as ensure that process design is working appropriately and accurately. Cooperation with UM , CM, Clinical Information Analyst, Regulatory and Compliance, Legal, Claims, Call Center Operations, Enrollment and Billing , and others as needed .

• Development of job aids and training material for the RightFax and HIE teams, as well as peer to Peer education.

• Attend virtual meetings with outside organizations to promote and educate on HIE material and process.

• Point of contact for vendor managers to assist in re-education of Healthfirst providers.

• Additional duties as assigned

Minimum Qualifications:

• Minimum 5 years’ experience in the healthcare field with k nowledge of Medical Terminology .

• Ability to execute and reconcile a high volume of data entry .

• Ability to prioritize and follow through on assigned tasks with minimal oversight .

• Administrative or c lerical experience on various computer applications .

• Minimum High school diploma or GED. Associates degree preferred.

Preferred Qualifications:

• Astute attention to detail, critical thinking skills, and analytical mindset.

• Interpersonal skills.

• Previous experience working with cross-functional teams.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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 careers@Healthfirst.org 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 Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement (http://www.dol.gov/agencies/ofccp/posters)

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.