Clinical Operational Rightfax Expert - Remote

Description and Requirements

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. The position is 100% remote Work Hours: Sunday to Thursday, 5 day work week from 8:00 am - 5:00 pm

Responsibilities:

• Electronic logging of documentation and subsequent notification to downstream entities including Utilization Management (UM), Care Management (CM) or other teams. Ensure that the input information is correct and complete, including member/provider information, medical records, and Protected Health Information (PHI).
• Data entry of authorization requests including location of services, medical diagnoses, and service codes; Telephonic outreach to providers or collaboration with UM Management required in some instances to confirm provider request information.
• Telephonic 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 department.
• 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.
• Cross departmental collaboration to investigate and solve operational 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 3 years' experience in the healthcare field with knowledge 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 clerical experience on various computer applications.
• Minimum High school diploma or GED.

Preferred Qualifications:

• Associates degree preferred.
• Astute attention to detail, critical thinking skills, and analytical mindset.
• Interpersonal skills.
• Previous experience working with cross-functional teams.

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.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.