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Medicare Advantage Provider Call Center Support Specialist - Remote

Health Care Service Corporation
life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
United States, New Mexico, Albuquerque
May 05, 2025
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position supports Medicare Advantage Intake Care Management including member and provider inbound calls and inquiries, primarily focusing on prior authorization requests. They guide callers through the process, gather necessary information, and ensure accurate documentation while meeting performance metrics. This position supports data entry and research, supporting provider and/or member non-clinical needs. This position also supports other areas of the organization as needed. Key Responsibilities: - Handle Inbound Calls: Process a high volume of calls daily, typically 50+ calls daily, seeking pre-authorization or other inquiries. - Gather and Verify Information: Collect patient, provider, and imaging center data, ensuring accuracy and adherence to privacy regulations (HIPAA, PHI). - Pre-Authorization Requests: Determine authorization requirements based on company policy, member benefit grids, and provider status. - Customer Service: Provide excellent customer service, resolving inquiries and complaints, and transferring complex cases appropriately. - Documentation: Accurately document all interactions and data entered into various systems. - Performance Metrics: Meet or exceed call handling goals, including average speed to answer, average handle time, and customer satisfaction. Job Requirements: High school diploma or GED 1 year of college and 2 years experience with communication systems including Fax, Email and Telephone 1 year experience with Medicare Advantage system(s) or healthcare systems (i.e.; hospital, doctor office, community based organization). Experience coordinating member needs, providing assistance to members, and analyzing member needs. Basic knowledge of medical or healthcare terminology. Knowledge of clinical systems (claims, enrollment, documentation). PC proficiency including Microsoft Office applications. Customer service skills. Verbal and written communications skills including developing written correspondence to internal and external stakeholders. Preferred Job Requirements College courses in medical field, human services, social work, psychology or related healthcare field Call Center Experience preferred Experience with CMS guidelines preferred Experience with precertification systems, including MHK, FACETS and/or QNXT strongly preferred Experience with Verint and Finesse strongly preferred Experience navigating KnowledgeXchange Need to be able to work independently with support and be resourceful Additional Work Details: Work Schedule: Any 8-hour shift during business hours of Monday - Friday, 7am CST - 7pm CST Telecommute: This is a Telecommute (Remote) role: Must reside within 250 miles of the offices locations listed or anywhere within the posted state. Must be able to hard-wire internet connection Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$17.75 - $27.83