Care Specialist-Clinical Operations

Role Summary

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title

Care Specialist-Clinical Operations

Responsibilities

Roles & Responsibilities

• May work in multiple products receiving inbound calls from members, physicians, clients and others to
• process requests per Sagility LLC policies and guidelines
• May work in multiple products conducting outbound call projects to members for enrollment purposes,
• customer satisfaction surveys, and other outbound projects

Routes messages to appropriate nurse and makes pertinent notes in patient charts when necessary.

Ensures that notes are clear and timely

• Uses applications according to policies and guidelines to ensure quality delivery of services.
• Maintains a mutually effective working relationship with callers, physician offices, clients, team

members, supervisors, and internal customers

Maintains confidentiality of all patients according to HIPAA standards.

• Collects and validates patient demographic information including insurance type and patient contact
• information
• Obtains pre-certification or authorization numbers if necessary for referral
• Regular, reliable attendance and timeliness
• Other duties as assigned

The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned

Requirements

Education

High School Diploma or equivalent required

• A minimum 1-year experience working in an office setting as a receptionist, telephone customer service representative, or telemarketing representative required. Direct experience in a telehealth support function preferred.
• Good communication skills via telephone with members, customers, peers and superiors
• With Basic Competency Level in the ff

Excellent interpersonal skills

Ability to understand and interpret policy provisions.

• Product knowledge
• Typing Skills
• Problem Solving Skills
• Proficient computer skills
• Demonstrates empathy

With Moderate Competency Level in the ff.

• Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible
• Ability to assist member in navigating the healthcare system and community-based resources
• Culturally sensitive and competent for assigned membership
• Strong organizational skills; ability to multi-task and be nimble
• Ability to work remotely
• Ability to determine when to escalate issues appropriately and in a timely manner