Job Description
Pay Range:
$53,400.00 - $72,000.00 Please email if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
At BCBSRI, our greatest resource is our people.
We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.
We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.
Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.
Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.
We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.
Why this job matters:
The DSNP Support Specialist provides administrative and operational support to the D-SNP Case Management department by assisting with member communications, report management, data entry, document translation, scheduling, and departmental follow-up tasks. This role supports clinical staff, helps ensure accurate and confidential processing of member information, and contributes to timely completion of regulatory, operational, and service-related activities.
What you will do:
- Respond to inquiries from internal and external customers; facilitate problem resolution through research. Refer call to appropriate resources in a timely manner.
- Interact with clinical staff to obtain health care information necessary for data entry, or quality and team initiatives. Perform data entry into the medical information system and other applicable data bases.
- Ensure adherence to regulatory, accreditation, and departmental standards.
- Assist team with department initiatives and projects.
- Run Daily/Weekly/monthly reports to support operational needs of the division and other duties as assigned to support corporate objectives.
- Support the ICT Process by pulling Invite report, scheduling members and managing ICT calendar.
- Support the DSNP Case Management document translation process by monitoring the translation inbox, submitting documents for translation, uploading translated documents into MHK and sending out to mail to members.
- Provide administrative support for the D-SNP Case Management department, including report management, data entry, member correspondence, and timely follow-up on departmental tasks.
- Ensure accurate, confidential processing and tracking of departmental data in alignment with workflows, regulatory requirements, and service standards.
- Support fulfillment team as needed.
- Perform other duties as assigned.
What you need to succeed:
- High school degree
- Two to four years experience in a medical, hospital, or third party payer setting.
- Experience handling confidential member or patient information.
- Experience using systems or databases to enter, track, and update information.
- Experience prioritizing time-sensitive tasks and following established procedures.
- Experience communicating with members, providers, vendors, or internal business partners.
- Knowledge of medical terminology
- Working knowledge of Microsoft Office including Excel, and Word
- General computer proficiency
- Strong Written and verbal communications skills
- Good organization skills
- Time management skills
- Strong attention to detail and accuracy.
- Ability to research and organize data
- Ability to organize work efficiently to meet established time and quality standards.
- Ability to manage multiple priorities and meet deadlines.
- Ability to follow workflows, identify issues, and escalate appropriately.
- Strong customer service and organizational skills.
The extras:
- Experience in a managed care environment
- Knowledge of state and federal health regulations and accreditation standards (e.g., NCQA, URAC, DOH, DHS, CMS)
- Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc
- Experience with Medicare Advantage, D-SNP, Medicaid, or government programs.
- Experience with MHK, similar systems, or other EMR systems.
Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
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In-office: onsite 5 days per week
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Hybrid: onsite 2-4 days per week
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Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.
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Originally posted on Himalayas
