Shared Services UM Support Specialist (2pm-11pm EST shift)

Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 33 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

Shared Services Team Overview

Our call center team operates as a unified entity, expertly managing two key areas: Provider Support and Non-Clinical Utilization Management (UM) Support. Every team member is cross trained to handle inquiries from both areas, ensuring comprehensive and versatile support for our providers. Although each specialist may have a primary focus in one subject area, their broad training allows them to assist with a wide range of topics, enhancing our efficiency and service delivery.

Shared Services Specialist are responsible for handling incoming calls, chats, emails, and faxes, providing initial support to providers for inquiries related to authorizations, claims, and general provider services. They accurately document interactions and maintain records of inquiries, resolutions, and follow-ups. When asked, Specialist troubleshoot standard issues and guide providers through processes such as checking authorization status or submitting claims. They focus on delivering exceptional customer service, building rapport with providers, and ensuring a positive experience. Agents adhere to policies and procedures to ensure compliance with industry regulations and company standards

Position Summary:

Our Non-Clinical UM Support Specialist provides healthcare providers with comprehensive and efficient assistance for all authorization-related tasks. Through multiple communication channels—including phone, chat, email, and fax—our experienced team ensures seamless handling of authorization requests and inquiries.

• Verify Procedure Codes for Prior Authorization Requirements


• Create Authorizations Request and Submit for Clinical Review


• Provide Authorization Status Updates


• Answer Provider Auth Inquires


• Make Outbound attempts to acquire supporting clinical documentation.

Our Authorization Support Call Center is designed to streamline the prior authorization process for providers, ensuring they receive timely approvals and updates. By offering proactive communication, multi-channel support, and expert guidance, we minimize administrative burdens, allowing providers to focus on patient care.

This comprehensive service offering ensures that all authorization-related tasks are handled with accuracy, transparency, and efficiency, making us a trusted partner for healthcare providers.

Education Requirements:

• High School graduate with diploma or equivalent.

Minimum Job Experience Required

• 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.

Schedule

• 2:00 pm - 11:00 pm 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 Align Senior Care/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.