Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Care Specialist

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Administrative & Support
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2013P Requisition #
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Summary of Job: To provide administrative support to the Medical Management Operations team, performing non-clinical tasks as assigned.

Requirements:
  • Works collaboratively, as a critical component of the concurrent review team, to facilitate all clerical and administrative processes and activities.
  • Performs accurate and timely intake and data entry for all inpatient notifications and lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements. Triages cases and assigns receipts to appropriate teams.
  • Responds to inquiries from providers, facilities and members.
  • Enters and maintains documentation in the medical management workflow tool meeting defined timeframes and performance standards.
  • Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and accreditation and business standards.
  • Initiates completion of member and provider correspondence and verbal outreach according to departmental guidelines
  • Communicates with members and providers regarding member’s authorization status, as required
  • Adheres to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
  • Supports communication and coordination with delegated entities, as necessary
  • Actively participates on assigned committees and projects
  • Perform other related projects and duties as assigned.
Qualifications:

  • Associates Degree or Medical Assistant certification preferred
  • At least 1-2 years of previous call center or data entry experience in a utilization or care management environment within managed care 
  • Strong oral, written and interpersonal communication skills required
  • Ability to work both independently and collaboratively with others
  • Previous system user experience in a highly automated environment required with strong PC skills required
  • Knowledge of medical terminology, ICD-10 and CPT coding preferred
  • Ability to prioritize multiple tasks

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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