Member Service Rep

* Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions.
* Respond and effectively triage member phone calls to accurately route to appropriate area.
* Work with care management team to address the needs of members, caregivers and other CCA constituents.
* Conduct all follow up activities in a timely and accurate manner ensuring member expectations are met.
* Meticulously document all member and prospective member interactions in a Centralized Electronic System.
* Responsible for the scheduling of member appointments, transportation, translation, and interpretation services.
* Initiates prior authorization intake process.
* Assist in resolving member billing discrepancies.
Provide members with any requested documents including provider listings in their areas.
* Complete comprehensive appeal and grievance intakes.
* Collaborate with the member to accurately document their appeal or grievance concern by ensuring all necessary information to start the process is captured.
* Assist with timely resolution of concerns or complaints conveyed by members and their representative.
* Conduct research to provide accurate and informed resolution to members inquiries.
* Collect supporting data and documentation relevant to members' care.
* Connect members to their CCA providers through Telemedicine accessibility.
* Must act in compliance with HIPAA, state and federal regulations when assisting CCA members
* Other duties as assigned

Working Conditions:

The MSR position requires the ability to sit at a desk, while talking on the telephone and using the computer, for eight hours each day in a distraction free environment.

Required Education:

* Associate's degree or equivalent experience.

Desired Education:

A bachelor's degree in any general or health-oriented field is preferred. Technical accreditation in the health care field (i.e., Medical Assistant | Billing and Coding) is a plus.

Required Experience:

* At least six months recent experience in a call center environment
* Currently or recently employed in customer service, public service, as front-line health care worker, or in a contact center

* Experience and competent in working with a diverse differently abled and elderly population, socioeconomically, ethnically, and culturally
* Experience working independently while in a team environment
* Experience working in a quality-focused environment with an emphasis on behavioral based quality assurance program
Desired Experience:

* Experience in health care, , health plan, insurance or government is preferred.
* Prior experience working in the health care industry front lines or medical setting preferred
* Prior experience with service authorizations, grievances and appeals, scheduling medical appointments preferred
* Ability to work with multiple computer programs and phone systems at once
Required Knowledge, Skills & Abilities:

* Must be passionate about serving others and able to show empathy to distressed individuals

* Skilled in problem solving by referencing departmental standard operating procedures and workflows
* Resilient and adaptable working in an environment that includes continuous change
* Proven proficiency working in a metrics, benchmarks and goals driven work environment.
* Reliability and punctuality are a must
* Proficient with Microsoft Office Suite and demonstrated ability to work with multiple complex systems simultaneously
* Document information clearly and efficiently using medical terminology
* Excellent interpersonal skills and ability to interact professionally
* Must be kind and respect when assisting all constituents including challenging callers, with excellence in customer service.
* Superb verbal and written communications skills in English required

Desired Knowledge, Skills & Abilities:

* Proficient in medical terminology preferred
* Proficiency in at least one other language strongly preferred

Member Facing: No

Other:

• Standard Office Equipment
• Remote Connectivity Equipment
• Physical Requirements: Ability to sit for long periods of time; light lifting, and bending
• Required: A broadband or cable internet connection with a minimum speed of 200 Mbps. Satellite Internet, T-Mobile 5G Internet and Mobile 5G hotspot will not be compatible with our systems.