Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in both the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics.

Summary:

The Shared Services Contact Center Specialist position is a non-clinical role and will be responsible for answering inbound/outbound calls, chats, and emails for both UM Intake and Provider Services functions. This position will be the primary point of contact for all communications between AllyAlign/Curana customers, (external hospitals, physicians, and Post-Acute Care providers).

This position will be expected to demonstrate a complete understanding of how to research and resolve customer service issues pertaining to pre-certification of services, member claims statuses, and other various provider inquiries. In addition, this role will be asked to understand the call flow for delivery of services and day-to-day operational provider concerns using defined processes. This position will be asked to demonstrate a full understanding and the ability to differentiate between the required processes across multiple states to ensure compliance with all Medicare guidelines by state and CMS regulations are adhered.

In addition to the previous tasks, this role will be responsible for communicating all state specific and national health care laws to external hospitals, physicians and post-acute care providers including the appeals/reconsideration policies. Inbound and outbound communications tasks include coordination of requests from hospitals, physicians, and post-acute care providers for pre and re-certification, status checks on existing claims, directing calls to internal departments, notification calls to hospitals and post-acute care providers regarding incomplete pre-certification requests, as well as authorization approvals.

Education Requirements:

• High School graduate with diploma or equivalent.
• Associate, bachelor’s degree, or previous experience in healthcare related field.
  

Minimum Job Experience Required (number of years necessary to perform role):

• 2+ years of experience in healthcare contact center/service-related area
• Medical background with knowledge of post-acute care experience desired
• Medicare claims knowledge.
• Experience with insurance products including Managed Care, Medicare Advantage, Medicare, and Medicaid desired.

Status: Full time

• Various schedules to cover operating hours (8AM - 11PM EST)
• Maintain flexibility to variations in work volume/work schedule, which sometimes require extended working hours.
• Position may require rotating weekend and holiday coverage. Certain postings may require regular weekend coverage based on business and client needs.
• Position is remote
  

Required Skills:

• Previous call center, customer service, and medical terminology experience required.
• Provides excellent customer service to clients and providers by ensuring there is full understanding of the resolution or action plan
• Ability to navigate multiple platforms that contain provider data, member information, and authorizations.
• Daily focus on attaining productivity standards, recommending innovative approaches for enhancing performance and productivity when appropriate.
• Time-management: Ability to effectively manage one's time and resources to ensure that work is completed efficiently. Excellent organizational skills.
• Communication: Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership.
• Critical-Thinking/Decision-making: Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities.
• Autonomy: Ability to work independently with little to no supervision.
• Ability to complete special projects or other duties as assigned.
• Proficient with various applications or software, such as: Microsoft Outlook, Word, Excel, and PowerPoint and demonstrate ability to utilize all resources to support the manual functionality of the AllyAlign/Curana Health system.
  

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.