Call Center Service Coordinator, Health and Recovery Plan
As a mission-driven health plan serving all 62 counties of New York State, Fidelis Care provides quality, affordable health insurance coverage for children and adults of all ages and at all stages of life. Central to our mission is our commitment to be a health care partner, working closely with our members and providers to ensure that everyone receives the care they need, when they need it. From the beginning, Fidelis Care has worked to be part of the social fabric of local communities, impacting people’s lives with one of the most basic human rights – access to quality health care and services, close to home.
The HARP Service Coordinator provides administrative and non-clinical member service support for members of the HealthierLife plan. The HARP Service Coordinator provides front-line response to members and providers requesting information on or access to Behavioral Health services. The position facilitates access, for clinical case management staff, to non-emergency care and triage requests as well as urgent and emergency care requests
Essential Functions and Responsibilities
Coordination and Documentation: Coordinates services and care related to HARP members, including scheduling appointments for Members, arranging transportation to appointments when necessary, obtaining health records from providers, identifying and securing providers for the Members, obtaining and documenting authorization information, placing appointment reminder and follow-up calls,
Complete all required and related paperwork and documentation in information systems/ electronic record (i.e. authorizations, securing provider assignments, etc.)
Data Input and Retrieval: Utilize computer systems in order to input orders, data, authorizations, access records and retrieve pertinent information when necessary.
Troubleshooting Customer Problems: Clarify the member's complaint; determine the cause of the problem; select and explain the best solution to solve the problem and expedite correction or adjustment; follow up to ensure resolution.
Computer Literacy: Transcribe, format, input, and edit information or data in order to generate letters, documents, spreadsheets, and authorizations. Proficient with Microsoft Office.
Spreadsheets: Create spreadsheets with appropriate data in order to provide others with required operational reports.
Care Coordination - nonclinical: Liaison to providers and care team regarding care processes. Problem solving of nonclinical issues. Assures timely access to clinical staff for triage and resolution of clinical issues
Care Management & Utilization Management Documentation: Complete documentation of care management support activities and creation and processing of prospective Utilization Management requests
Care Management support: Routine contact with members, providers, and Health Homes to facilitate referrals and follow through on services based on care plan, as directed by Care Manager.; Complete related documentation of support activities.
HARP Program Support: Alert department of any suspected fraudulent activity. Authorizations and closing of cases.
HARP Care Manager Support: Assist HARP Care Managers doing high acuity clinical cases. Assist with reports, generating letters, follow up phone calls, and other requirements.
Other duties as required: Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes.
Educational and Experience Requirements
Work Related Experience:
1-2 Years Managed Care/Behavioral Health Insurance Experience Preferred
Minimum 1 Year Customer Service Experience: Ensure timely and professional interactions with customers.
Good working knowledge of recovery oriented Behavioral Health services preferred.
Good working knowledge managed care insurance concepts and regulations preferred.
1 to 2 years related experience required.
Education, License, and Certification Requirements
High School Diploma required.
Associate or Bachelors degree preferred
Buffalo Regional Office