Modivcare
Exception Specialist III
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Exception Specialist III to join our team. This position is responsible for facilitating various client procedures, managing standing orders, and coordinating transportation services. This role involves addressing attendance challenges, distributing mass transit information, and evaluating mileage requests for compliance and cost-effectiveness. It also includes researching and resolving issues, monitoring phone activity for efficiency, and identifying trends indicative of abusive practices. This Role Includes
Facilitating various client-related procedures including Minor Consent Forms, Attendant Forms, Plan of Care documents, and Trip Limits. Ensuring accuracy and compliance with established protocols and regulatory requirements. Creating, modifying, and recertifying standing orders via digital, web-based, phone, and fax channels. Documenting attendance challenges using the Attendance Recovery Workbook. Distributing mass transit information and resources for effective communication. Evaluating and approving excessive mileage requests for compliance and cost-efficiency. Securing prior authorizations for transportation services by coordinating with healthcare providers and insurance entities. Processing CMMNAs and/or LMN requests in accordance with procedural requirements. Coordinating fair hearings and denial appeals, collaborating with stakeholders to resolve issues efficiently. Managing spend-down activities including expenditure tracking and reporting. Collecting receipts and handling invoicing for meals and lodging related to transportation services. Maintaining a comprehensive facility rolodex with up-to-date contact information for healthcare facilities and service providers. Monitoring Westfax operations and ensuring prompt issue resolution and data integrity. Recommending downgrades in level of service to reflect members' changing needs. Reviewing cancellations for standing order riders and implementing corrective actions. Communicating trip updates via email, LCAD system, or other tools in real-time. Administering the provider liquidated damage process, including documentation and resolution of claims related to service disruptions or contract breaches. Ensuring trip data is accurately entered and resolved according to service guidelines. Researching and resolving issues related to benefit utilization, eligibility verification, waivers, urgent trip requests, and denial processes. Advising management on customer service and exceptions processing. Overseeing inbound and outbound phone activity for quality and operational efficiency. Investigating utilization and billing patterns to detect and report abusive practices. May generate and issue Denial/RNS letters for non-serviced requests or denied claims. May lead special projects and perform other duties as assigned. We Are Interested In Speaking With Individuals With The Following
High School Diploma required. Two (2) plus years of relevant experience. Or equivalent combination of education and/or experience. Excellent customer service and interpersonal skills. Ability to work both independently and as part of a team. Quick to learn new technologies and processes. Strong ability to follow complex instructions and resolve issues. Proficient in written and spoken English. Exceptional attention to detail and accuracy. Skilled in managing multiple tasks while maintaining service quality. Salary: $16.36 - $22.09/hr
Modivcare's positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received. We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings. We value our team members and realize the importance of benefits for you and your family. Modivcare offers a comprehensive benefits package to include the following: Medical, Dental, and Vision insurance Employer Paid Basic Life Insurance and AD&D Voluntary Life Insurance (Employee/Spouse/Child) Health Care and Dependent Care Flexible Spending Accounts Pre-Tax and Post-Tax Commuter and Parking Benefits 401(k) Retirement Savings Plan with Company Match Paid Time Off Paid Parental Leave Short-Term and Long-Term Disability Tuition Reimbursement Employee Discounts (retail, hotel, food, restaurants, car rental and much more!) Modivcare is an Equal Opportunity Employer. We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law.
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Exception Specialist III to join our team. This position is responsible for facilitating various client procedures, managing standing orders, and coordinating transportation services. This role involves addressing attendance challenges, distributing mass transit information, and evaluating mileage requests for compliance and cost-effectiveness. It also includes researching and resolving issues, monitoring phone activity for efficiency, and identifying trends indicative of abusive practices. This Role Includes
Facilitating various client-related procedures including Minor Consent Forms, Attendant Forms, Plan of Care documents, and Trip Limits. Ensuring accuracy and compliance with established protocols and regulatory requirements. Creating, modifying, and recertifying standing orders via digital, web-based, phone, and fax channels. Documenting attendance challenges using the Attendance Recovery Workbook. Distributing mass transit information and resources for effective communication. Evaluating and approving excessive mileage requests for compliance and cost-efficiency. Securing prior authorizations for transportation services by coordinating with healthcare providers and insurance entities. Processing CMMNAs and/or LMN requests in accordance with procedural requirements. Coordinating fair hearings and denial appeals, collaborating with stakeholders to resolve issues efficiently. Managing spend-down activities including expenditure tracking and reporting. Collecting receipts and handling invoicing for meals and lodging related to transportation services. Maintaining a comprehensive facility rolodex with up-to-date contact information for healthcare facilities and service providers. Monitoring Westfax operations and ensuring prompt issue resolution and data integrity. Recommending downgrades in level of service to reflect members' changing needs. Reviewing cancellations for standing order riders and implementing corrective actions. Communicating trip updates via email, LCAD system, or other tools in real-time. Administering the provider liquidated damage process, including documentation and resolution of claims related to service disruptions or contract breaches. Ensuring trip data is accurately entered and resolved according to service guidelines. Researching and resolving issues related to benefit utilization, eligibility verification, waivers, urgent trip requests, and denial processes. Advising management on customer service and exceptions processing. Overseeing inbound and outbound phone activity for quality and operational efficiency. Investigating utilization and billing patterns to detect and report abusive practices. May generate and issue Denial/RNS letters for non-serviced requests or denied claims. May lead special projects and perform other duties as assigned. We Are Interested In Speaking With Individuals With The Following
High School Diploma required. Two (2) plus years of relevant experience. Or equivalent combination of education and/or experience. Excellent customer service and interpersonal skills. Ability to work both independently and as part of a team. Quick to learn new technologies and processes. Strong ability to follow complex instructions and resolve issues. Proficient in written and spoken English. Exceptional attention to detail and accuracy. Skilled in managing multiple tasks while maintaining service quality. Salary: $16.36 - $22.09/hr
Modivcare's positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received. We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings. We value our team members and realize the importance of benefits for you and your family. Modivcare offers a comprehensive benefits package to include the following: Medical, Dental, and Vision insurance Employer Paid Basic Life Insurance and AD&D Voluntary Life Insurance (Employee/Spouse/Child) Health Care and Dependent Care Flexible Spending Accounts Pre-Tax and Post-Tax Commuter and Parking Benefits 401(k) Retirement Savings Plan with Company Match Paid Time Off Paid Parental Leave Short-Term and Long-Term Disability Tuition Reimbursement Employee Discounts (retail, hotel, food, restaurants, car rental and much more!) Modivcare is an Equal Opportunity Employer. We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law.