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!

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. Will additionally, be involved in researching and resolving issues, monitoring phone activity for efficiency, and addressing trends indicative of abusive practices.

This role…

• Facilitates various client-related procedures, including but not limited to Minor Consent Forms, Attendant Forms, Plan of Care documents, and Trip Limits.

• Ensures accuracy and compliance with established protocols and regulatory requirements.

• Creates, modifies, and recertifies standing orders through digital, web-based, phone, and fax channels.

• Documents in the Attendance Recovery Workbook to address attendance-related challenges.

• Distributes mass transit information and resources for timely communication and coordination.

• Evaluates and approves requests for excessive mileage, ensuring compliance and cost-effectiveness.

• Facilitates the process of obtaining prior authorizations for transportation services.

• Liaises with healthcare providers and insurance entities to secure necessary approvals.

• Processes CMMNAs and/or LMN, ensuring compliance with established protocols.

• Facilitates fair hearings and denial appeals, collaborating with stakeholders for smooth resolution.

• Manages spend down activities, tracking and reporting expenditures per regulatory requirements.

• Collects receipts and handle invoicing process for meals and lodging associated with transportation services.

• Maintains a comprehensive facility rolodex with accurate contact information for healthcare facilities and service providers.

• Monitors Westfax operations, promptly addressing issues and ensuring data integrity.

• Suggests level of service downgrades, aligning transportation services with changing member needs.

• Reviews previous day cancellations for standing order riders, implementing corrective actions.

• Communicates trip updates promptly via email, LCAD system, or other channels for real-time information sharing.

• Administers the provider liquidated damage process, including assessment, documentation, and resolution of claims related to service disruptions or contractual breaches.

• Ensures accurate trip data input and resolution according to service guidelines.

• Researches and resolves issues requiring further action, such as benefit utilization, verification, waivers, urgent trip requests, and process denials.

• Observes and advises the management team on customer service and exceptions process.

• Manages and oversees the department's inbound and outbound phone activity for quality and efficiency.

• Investigates issues to confirm actual utilization, identify, and monitor utilization and billing trends signaling abusive practices.

• Reports to management the need to address abusive or fraudulent situations.

• May generate and issue Denial/RNS Letters for denied claims or non-serviced requests.

• May lead projects and perform other duties as assigned.

We are interested in speaking to individuals with the following…

• High School Diploma required.

• Two (2) plus years of experience.

• Or equivalent combination of education and/or experience.

• Excellent customer service and people skills.

• Works independently or with a team.

• Quickly learns new technology and processes.

• Understands and follows complex instructions; handle complex issues.

• Proficient in writing, reading, and fluency in speaking English.

• Accurate and attention to detail.

• Ability to handle multiple tasks without compromising the quality of service.

Salary: $16.36-$22.09/hourly

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.

• EEO is The Law - click here for more information
• Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
• 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. If you need assistance, please reach out to us at [email protected]