Job Description
Modivcare is looking for an experienced Exception Specialist I to join our team. In this role, you will be responsible for ensuring the accurate fulfillment and approval of transportation service requests and reservations before and/or after transport, through internal systems, external resources, and direct outreach to members, facilities, clients, and other stakeholders.
This role…
- Ensures accurate input and resolution of trip data in accordance with service guidelines.
- Monitors and advises management on customer service and exception processing issues.
- Researches and resolves actions such as benefit utilization issues, eligibility, pre-authorizations, mileage validations, level of service, meals and lodging, denials, and appeals.
- Manages the denial and appeal process for transportation service requests.
- Processes inbound and outbound communications including faxes, emails, web submissions, and mail.
- Oversees phone interactions for quality and efficiency within the department.
- Investigates and verifies actual utilization for service claims and requests.
- Identifies trends in utilization or billing that may indicate abusive practices and reports them accordingly.
- Escalates reports of member dissatisfaction or potentially fraudulent behavior to the appropriate team or management.
- Provides outreach on transportation and member education to healthcare facilities as needed.
- May participate in additional projects or duties as assigned.
We are interested in speaking with individuals with the following
- …High School Diploma required
- .Zero (0) plus years of experience
- .Or equivalent combination of education and/or experience
- .Excellent customer service and interpersonal skills
- .Ability to work independently and within a team environment
- .Strong ability to learn new technologies and follow complex processes
- .Proficient in reading, writing, and understanding English
- .Demonstrates strong problem-solving, adaptability, and organizational skills
- .Able to remain professional and composed under pressure
.
Salary: $16 - $18/
hr