We are currently hiring a TEMPORARY Health-related Social Needs (HRSN) Specialist! If you are highly detail-oriented, thrive in a fast-paced environment, and have the ability to interpret and apply policies, regulations, and program requirements, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!
Classification: NON-EXEMPT | Status & Schedule: FULL-TIME, TEMPORARY (position is estimated to be operationally necessary through September 2027, though subject to change), MONDAY – FRIDAY, 8AM – 5PM
Location: REMOTE, must reside in list of approved states (OR, CA, AZ, TX, FL)
Salary: $19.84 - $25.68/HOURLY
Department: QUALITY | Reports to: CHIEF COMPLIANCE & QUALITY OFFICER | Supervision Exercised: NON-SUPERVISORY
Job Purpose: HRSN Program Specialist
The HRSN benefit includes cost-effective services that address the unmet, adverse social conditions that contribute to an individual’s poor health and are a result of underlying social determinants of health. This position is responsible for the centralization and coordination of the HRSN benefit, while maintaining a customer-oriented approach to ensure that the HRSN benefit process is easily accessed and utilized by internal and external stakeholders. This position provides support to health plan members and providers, serves as a resource for staff and provider network while processing HRSN requests and inquiries.
Qualifications, Education, & Experience - Minimum High School Diploma or GED; Associate degree in business administration preferred
- Minimum two years’ experience in a medical office, clinic or healthcare administration setting and two years’ experience in customer service-related position.
- One to two years' experience analyzing data and information
- Knowledge of medical terminology required
- Experience in accounting or budget-related position preferred
- Microsoft Office certification preferred
- THW Certification preferred, or willing to obtain within one year of hire
- Bilingual preferred, qualified, certified, or willing to obtain
Essential Responsibilities: HRSN Program Coordination - Maintain HRSN benefit expertise and knowledge, managed care principles, OHA requirements, and OHP benefits and incorporate this information into the HRSN coordination processes
- Assist with the development, implementation, and maintain a centralized HRSN benefit process to coordinate member needs and spending in a smooth, streamlined process
- Review HRSN requests for appropriate utilization, accuracy, and completeness based on applicable criteria guidelines
- Authorize HRSN requests in compliance with contractual agreements, Health Plan guidelines and appropriate company policy criteria
- Maintain accurate and timely documentation within the internal system, providing rationale for decisions made during the review process; this includes but is not limited to the request process and financial tracking
- Enter and maintain accurate and timely encounter data and claims information in company transactional system
- Ensure effective and compliant administration of the HRSN benefit process by coordinating communication and addressing the needs of affected departments
- Educate and assist employees in navigating the HRSN benefit process
- Assist with creating, maintaining, and updating all written and electronic documents related to HRSN benefit process
- Assist in the development and revision of HRSN-associated policies, procedures, and processes as directed
- Create reports, memos, letters, forms, and other documents relevant to HRSN benefit process
- Understand the HRSN benefit process and related contractual and organization requirements
- Participate in quality and organizational process improvement activities and teams when requested
- Assist in audit preparation when focus is HRSN benefit
- Participate, as needed, in weekly Executive Committee FlexFund meetings to ensure the timely determination of high dollar requests
- Assist Chief Compliance and Quality Officer, HRSN department, and other internal stakeholders to review trends, barriers, and propose solutions to HRSN benefit processes
- Maintain awareness and use of continuous quality improvement tools and propose solutions for program development and expansion
- Participate in quality and organizational process improvement activities and teams when requested
- Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
- Handle confidential information and materials appropriately and maintain a secure work area
- Other duties as assigned
Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER - Participate in quality and organizational process improvement activities when requested
- Support and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
- Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
- Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
- Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
- Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
- Advance personal knowledge base by pursuing continuing education to enhance professional competence
- Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
- Represent organization at meetings and conferences as applicable
Knowledge, Skills, & Abilities: - Knowledge of administrative and clerical functions and procedures
- Knowledge of Microsoft and Adobe software
- Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services and evaluation of customer service satisfaction
- Knowledge of evidence-based practices and requirements to evaluate existing standards and implement new procedures
- Understanding of principles of health care of populations
- Knowledge of OHP program requirements, benefit package, eligibility categories, and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred
- Knowledge of the Oregon Health Authorities Coordinated Care Organization required metrics
- Knowledge of ICD, CPT, and HCPCS codes
- Understanding of basic concepts of managed care
- Critical attention to detail for accuracy and timeliness
- Solid presentation skills, ability to tailor presentations based on audience and expected outcomes
- Ability to report to work as scheduled, and willingness to work a flexible schedule when needed
- Proficient in Microsoft Office Suite and Windows Operating System (OS)
- Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
- Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
- Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
- Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
- Excellent people skills and friendly demeanor
- Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
- Attention to detail and organization skills
- Ability to handle stress and sensitive situations effectively while projecting a professional attitude
- Ability to communicate professionally, both conversing and written
- Ability to work with diverse populations and interact with people of differing personalities and backgrounds
- Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
- Ability to organize and work in a sensitive manner with people from other cultures
- Poised; maintains composure and sense of purpose
Working Conditions:This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information. Work Condition: Remote- Employee generally works within a remote work from home environment.
- Travel may be required on occasion.
- Hours of operations and specific staff scheduling may vary based on operational need.
Exposed to:- Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.
- Machines, equipment, tools, and supplies used: Constantly operates a computer or other office productivity machinery or software, such as fax, copier, calculator, multi-line telephone system, or scanner.
- May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information.
- Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
Other Information:
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
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