Member Services Call Center 23-00677 - Alura Workforce Solutions
Rancho Cucamonga, CA 91730
About the Job
Position
Member Services Call Center
Description
Under the general direction of the UM Manager of Operations and Supervisor, the Member Services Call Center, is a high paced position that requires timely answering of telephone calls from Members, asking to complete, create, redirect and/or service authorization requests. This position requires that one be organized, ability to multitask, set priorities and manage time effectively. a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The UM Coordinator will also ensure that Member calls are responded to in an accurate and timely manner while always maintaining highest level of customer service.
1. Responsible to manage large amounts of inbound Member calls in a timely manner.
2. Develop a sustainable working relation with Members and Providers by offering excellent customer support, ensuring that their needs are met, and going the extra mile by engaging to problem solve and find solutions.
3. Responsible to provide service to Members by approving, redirecting, modifying, correcting, and/or creating Member's authorizations by accurately entering information as requested by Provider and creating new authorization that will allow Providers to render services.
4. Responsible for utilizing job aids, guides, and tools to ensure that the Provider's request can be completed within the rules and/or restrictions in our guidelines.
5. Identify Member's needs, clarify information, research every issue and provide solutions and/or alternatives.
6. Document and keep records of your process and all conversations in MedHOK in a comprehensible way.
7. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level and to collaborate with other Team Members to ensure that the entire team is also successful at meeting those standards.
8. Responsible for meeting the QA standards for phone calls and to collaborate with other Team Members to ensure that the entire team is also successful at meeting those standards.
9. Responsible for representing the Inland Empire Health Plan in a professional, courteous, and friendly manner while answering the calls for the Utilization Management Department.
10. Assist UM Management or Utilization Management Nurses as requested.
Requirements
ZIPH
Member Services Call Center
Description
Under the general direction of the UM Manager of Operations and Supervisor, the Member Services Call Center, is a high paced position that requires timely answering of telephone calls from Members, asking to complete, create, redirect and/or service authorization requests. This position requires that one be organized, ability to multitask, set priorities and manage time effectively. a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The UM Coordinator will also ensure that Member calls are responded to in an accurate and timely manner while always maintaining highest level of customer service.
1. Responsible to manage large amounts of inbound Member calls in a timely manner.
2. Develop a sustainable working relation with Members and Providers by offering excellent customer support, ensuring that their needs are met, and going the extra mile by engaging to problem solve and find solutions.
3. Responsible to provide service to Members by approving, redirecting, modifying, correcting, and/or creating Member's authorizations by accurately entering information as requested by Provider and creating new authorization that will allow Providers to render services.
4. Responsible for utilizing job aids, guides, and tools to ensure that the Provider's request can be completed within the rules and/or restrictions in our guidelines.
5. Identify Member's needs, clarify information, research every issue and provide solutions and/or alternatives.
6. Document and keep records of your process and all conversations in MedHOK in a comprehensible way.
7. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level and to collaborate with other Team Members to ensure that the entire team is also successful at meeting those standards.
8. Responsible for meeting the QA standards for phone calls and to collaborate with other Team Members to ensure that the entire team is also successful at meeting those standards.
9. Responsible for representing the Inland Empire Health Plan in a professional, courteous, and friendly manner while answering the calls for the Utilization Management Department.
10. Assist UM Management or Utilization Management Nurses as requested.
Requirements
- Minimum of one year of experience as a Call Center Representative.
- Experience as a Caller Center Representative preferably in an HMO or Managed Care Setting. Managed Care or physician office experience preferred.
- High School Diploma or GED required.
- Bilingual Spanish required
- Associate Degree from an accredited institution preferred.
- Medical Assistant certificate preferred.
- Knowledge of ICD-9/10 and CPT code preferred.
- Knowledge of computer applications, including word processing, database and spreadsheets. Good customer service skills a must.
- Skilled in computer applications, including word processing, database and spreadsheets. Good customer service skills a must.
ZIPH
Source : Alura Workforce Solutions