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.

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

Compensation: $17.75 - $27.83

Exact compensation may vary based on skills, experience, and location

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards

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Medicare Advantage Provider Call Center Support Specialist - Remote

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