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.

• Facilitates various client-related procedures including 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 via digital, web-based, phone, and fax channels.

• Documents attendance challenges using the Attendance Recovery Workbook.

• Distributes mass transit information and resources for effective communication.

• Evaluates and approves excessive mileage requests for compliance and cost-efficiency.

• Secures prior authorizations for transportation services by coordinating with healthcare providers and insurance entities.

• Processes CMMNAs and/or LMN requests in accordance with procedural requirements.

• Coordinates fair hearings and denial appeals, collaborating with stakeholders to resolve issues efficiently.

• Manages spend-down activities including expenditure tracking and reporting.

• Collects receipts and handles invoicing for meals and lodging related to transportation services.

• Maintains a comprehensive facility rolodex with up-to-date contact information for healthcare facilities and service providers.

• Monitors Westfax operations and ensures prompt issue resolution and data integrity.

• Recommends downgrades in level of service to reflect members' changing needs.

• Reviews cancellations for standing order riders and implements corrective actions.

• Communicates trip updates via email, LCAD system, or other tools in real-time.

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

• Ensures trip data is accurately entered and resolved according to service guidelines.

• Researches and resolves issues related to benefit utilization, eligibility verification, waivers, urgent trip requests, and denial processes.

• Advises management on customer service and exceptions processing.

• Oversees inbound and outbound phone activity for quality and operational efficiency.

• Investigates 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.

• 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.

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]