Customer Care Associate I - San Leandro, United States - Community Health Center Network

Description

Job Description Job Description Organizational Description The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County.

CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health.

In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

Position Title:

Customer Care Associate IDepartment:
Customer Care

Reports To:
Customer Care SupervisorClassification: Non

• ExemptStatus: Full Time (Regular)POSITION SUMMARYWith supervision, develop and maintain a broad, integrated understanding of programs, policies, and procedures within CHCN.

Answer and respond to CHCN-MSO related customer issues that are received by way of telephone to meet customer expectations and departmental goals and objectives.
ESSENTIAL POSITION RESULTSThe essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned. Respond and resolve all first level, inbound inquiries and issues regarding member eligibility, claims, authorizations, and provider services.
Consistently utilize multiple resources to resolve inquiries while on the phone.
Follow through on customer issues promptly and accurately until completion.
Transfer complex issues to appropriate staff after completely and accurately acquiring information regarding issue.
Accurately update and document EZCAP Customer Service records with all information pertaining to more complex inquiries.

Communicate with the members, physicians, internal departments and other internal and external customers in a professional, courteous, and respectful manner to reflect CHCNs goal of excellent customer service.

Suggest efficiencies that will benefit the department.
Promote the usage of CHCN Connect Portal and provider procedural support for existing users.


Auditing Daily Open Incident reports:
closing CSI that are open and calling providers back if necessary.
Assist members that come into the office with questions about membership.

Grievance and Appeals Process the Health Plans Completing denial packetsForwarding requested medical records to HMO by due date requestedForwarding Quality Improvement (complaints) to clinics and forwarding their responses back to the HP by due date requestedTracking grievance and appeals on CSI and ExcelComplete Daily Assignments:

Voice Mail processingTPL requests from the Health PlanTPL requests from Law FirmsMember BillsReply to emails Customer Care inboxCustomer Care Fax inboxPortal Support EmailsRemote Access RequestsHIPAA Designated AccessFor the purposes of the job duties of this position, the person in this position requires access only to the following HIPAA protected information data sets1.

MSO Membership2. MSO Claims3. MSO Referral/Auth4. MSO Capitation5. Data Warehouse6. Chart Audit/QI7.

Disease RegistrySUPERVISORY RESPONSIBILITIESNoneMINIMUM QUALIFICATIONSRequired Skills and Experience13 years experience of commonly used customer service concepts, practices and proceduresAbility to create a satisfied customer experience through energetic, passionate attention to the customer experienceAbility to guide and manage a customer call.

Ability to summarize customer issues and identify paths to solutions.

Ability to answer inbound calls per day from members, providers offices, health plans and other external customersAbility to learn and implement new ideas, processes, procedures quicklyAbility to work collaboratively within a teamAbility to communicate effectively both orally and in writing.

Desired ExperienceBi-lingual in Spanish, Cantonese, or Vietnamese a plusHealthcare background working with MSOs, or medical billing a plusRequired EducationHigh school diploma required, 2 year college degree preferred.

General CHCN Roles Fosters an environment that promotes trust and cooperation among clients and staff. Enforces policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented. Accountable for participating in decision making processes and understanding the outcome(s). Understands the values and principles of CHCN and applies them in work responsibilities. Participates in outreach activities, agency advocacy, and serves on ad hoc committees, as requested.

CERTIFICATES AND/OR LICENSESNonePHYSICAL DEMANDSThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel.

The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENTThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly exposed to an inside environment.#J-18808-Ljbffr