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PURPOSE

The Support Specialist supports the Population Health Management (PHM) program in day to day operations, patient outreach and reporting requirements. The Support Specialist has a basic understanding of care coordination processes to support and intervene in areas allowable under the scope of practice for this role. Must have the ability and willingness to develop expertise related to the operational functions of the PHM program. The role requires effective communication skills to engage collaboratively with PHM staff, other health care professionals and patients/members. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS

• Provides administrative and technical support through knowledge of operational needs for the department, including:
• Managing phones and emails
• Other PHM clerical functions
• Reviews referrals for case management intensity and routes to appropriate nurse for review
• Requests medical records from provider for review as needed
• Provides data entry of faxed referrals and review for coordinator approval
• Coordinates care with providers for patients to access services, as assigned
• Verifies eligibility and benefits for qualifications of services
• Performs professional customer service and efficient problem solving for all health services related calls
• Maintains and provides resource information to PHM staff members
• Sends discharge survey letters to patients/families
• Maintains turnaround time compliance in all aspects of the PHM standards and regulatory process
• Actively participates in process improvement activities and perform audits, as assigned
• Collects data and provides statistical information and regular updates to supervisor/ manager on programs and projects
• Provides efficient and effective communication among care management staff, members and all other health care providers (internally/externally).
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Has regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available on CMSweb.

OTHER DUTIES AND RESPONSIBILITIES

• Performs other duties as assigned.
• Understands, adheres to, and implements the company’s policies and procedures.
• Provides excellent customer services, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients.
• Takes personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engages in excellent communication which includes listening attentively and speaking professionally.
• Participates in projects and other duties as assigned by Market Leadership
• Demonstrates attention to detail and accuracy in work product
• Sets and completes challenging goals.

QUALIFICATIONS

Education and Experience

Required:

• High School diploma or equivalent
• Intermediate knowledge of Microsoft Office required

Preferred:

• 2-3 years medical and/or healthcare experience
• Medical Terminology course/knowledge
• Process improvement and/or project management experience preferred
• Must demonstrate strong verbal and written communication skills
• Must demonstrate ability to work as part of the team

Knowledge, Skills, and Abilities:

• Prior experience scheduling appointments preferred.
• Broad knowledge of ARC’s operations, preferred.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• Ability to work in a team oriented environment.
• Knowledge of medical terminology
• Ability to think critically and rationally for decisions that meet the patient and ARC’s needs.
• Ability to work independently.
• Ability to problem-solve and offer suggestions for process improvements to other coordinating departments.
• Ability to create, sort and manipulate data in Excel spreadsheets.

Schedule:

M-F 8:00am - 5:00pm