Managed Care Administrative Specialist

AgeSpan

About Us: Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our agency is a thought-leader, a nationally known generator of new ideas, because it welcomes creativity, your ideas. It is an outstanding place to work stimulating, friendly, collaborative. We offer competitive salaries, generous vacation time, and an excellent work/life balance. We value diversity and encourage career growth. If you have a passion for improving the lives of the elderly community and enjoy working in a diverse team driven by its mission, you've found the right place!

At AgeSpan, you'll find a work environment that combines:

• A refreshing culture that is supportive, collaborative, and encouraging of diverse perspectives and backgrounds.
• A focus on innovation with a team recognized for developing and implementing innovative programs and novel solutions.
• Encouragement of your development through opportunities to get involved, use your voice, and gain new knowledge and skills.
• A satisfying balance between your work and personal life, including a flexible workplace, generous paid time off, and wellness programs.

Depending on your role and your hours, we offer

• Flexible schedule and hybrid work opportunities
• Competitive salaries
• Healthcare (medical, dental)
• 403b Retirement Plan with agency match
• 20 Vacation Days, 12 Sick Days, and 12 Paid Holidays
• Social Work Licensing Program
• License Renewal Paid by agency for RN's and Social Workers
• And MORE!

Position Responsibilities: Provide specialized administrative and operational support to the Managed Care Department, with a focus on service authorizations, enrollment activities, billing denials, data integrity, and communications with internal and external partners.

Essential Functions: (Core duties or tasks that are fundamental and not marginal to the performance of the job.)

• Oversee and complete service authorizations by coordinating provider referrals through the service procurement process, confirming service start dates, notifying the Geriatric Support Services Coordinator (GSSC), and entering authorizations into Aging & Disability (A&D) database (WellSky). Ensure timely communication with members through GSSC.
• Process enrollment transfers by completing data entry in A&D, notifying GSSC or Home Care, Care Manager and reviewing the final enrollment roster to verify accurate system updates.
• Manage disenrollment closures by completing required documentation, notifying providers of service closures, coordinating with GSSC, and ensuring communications are sent back to health plan as needed.
• Coordinate Consumer Directed Care (CDC) to Personal Care Attendant (PCA) transfers by working with the PCA Team to verify accurate transfer dates, ensuring updates are reflected in A&D, and utilizing PCA Partner when applicable.
• Add new member enrollments into A&D based on the monthly enrollment roster, ensuring accurate and timely data entry.
• Collaborate with internal teams, providers, and external partners to maintain accurate records, facilitate seamless service transitions, and ensure compliance with organizational policies and procedures.
• Maintain Elira reports, performing ongoing data review and cleanup to ensure accuracy and integrity within the A&D database.
• Conduct ongoing membership roster reviews and reconcile data in A&D to maintain accurate member records.
• Complete monthly assessment billing and submit documentation to the manager for review and approval.
• Collaborate with the Fiscal Department to identify and resolve service authorization-related issues, reducing claim denials and improving billing accuracy.
• Support management with the creation, maintenance, and updating of digital and paper forms, documents, and other administrative materials.
• Upload required documentation and accurately record member-related activities within the A&D database.
• Prepare member packets, mailings, and other materials, and provide administrative support for recurring and special projects as assigned.
• Participate in required trainings, departmental meetings, and agency-wide meetings.
• Perform other related duties and responsibilities as assigned.

Qualifications: Associates Degree with 2 years of administrative support experience required, preferably in the areas of medical billing or healthcare prior authorization processing. High school diploma with at least five years of administrative experience may be considered. Proficient in Office 365 with the ability to master new procedures with minimal oversight; strong interpersonal and organizational skills, critical thinking, attention to detail, able to prioritize, multitask and work well in a fast-paced team environment. Must work well independently as well as collaboratively. Prior experience with large client databases a plus.

Hours: 37.5 hours per week

At AgeSpan, we carefully consider a wide range of factors when determining rate of pay. Actual rate of pay depends on factors including but not limited to internal equity, experience, and qualifications. The pay range for this position is $24.00 - $27.00/hour.

Our Commitment to Diversity and Inclusion

AgeSpan is strongly committed to fostering a professional environment that recognizes, respects, and encourages the unique contributions of a broad spectrum of qualified employees. It is important that our employees reflect the diverse communities we serve. We maintain a work atmosphere that allows people of varied backgrounds to grow professionally and contribute to our mission by promoting diversity, equity, inclusion, and work-life balance.