Communicates internally and externally with members or clients to coordinate reports, data entry and tracking of tasks for various programs. Participates in non-clinical customer service for members or clients. Provides administrative support to staff. Works under general supervision.
Responsibilities
Identifies nature of issues, independently responds to and resolves non-clinical issues and complaints and escalates clinical issues to appropriate department and staff.
Assists in monitoring member and client satisfaction through phone calls to verify service, answering questions and providing information. Documents service issues, identifies trends and recommends potential solutions.
Maintains program specific expertise and organization structure. Acts as a resource to member or client.
Serves as a resource in the resolution of member or client-related issues.
Establishes effective customer-focused working relationships with members and/or clients, physicians, and providers of long-term care services.
Participates in team meetings and provides input on customer service-related activities.
Protects the confidentiality of member or client information and adheres to company policies regarding confidentiality.
Ensurescompliance with VNSNY policies and procedures as well as all Federal and State regulations.
Participates in special projects and performs other duties as assigned.
For Partners in Care ONLY:
Provides reports and analysis as required by the program.
Works with team members to ensure that daily program tasks are completed including telephone calls to prospective program participants.
Tracks visits scheduled and completed by clinical team and follows up on completion as needed.
Coordinates telephonic intake and responses to both clinical and non-clinical customer service issues.
For CHOICE ONLY:
Coordinates telephonic intake and scheduling of visits for clients.
Works with members, providers, and staff to identify and resolve member service and retention related issues. Educates potential members/community representatives on plan features, plan benefits, and program admission requirements.
Communicates with members and their families regarding information about MLTC services.
For CMHS ONLY:
Monitors and tracks the progress of clients/members with complex psychiatric and/or co-morbid medical conditions.
Educates potential clients/members on program features, benefits, and admission requirements.
Tracks all medical, behavioral, substance use, and network referrals made for client/member; ensures that client/member follow up on referrals and attend scheduled appointments.
Calls clients/members to remind them of important appointments and/or initial appointments to new service providers. Provides phone outreach to clients/members who have been non-compliant with necessary treatment appointments or have missed appointments for initial visits with new providers.
Ensures that relevant team members receive important client/member alerts, including ED visits, hospitalization admission/discharge information, and other urgent notifications.
Monitors client/member entitlements, insurance and benefits to ensure they remain in place. Alerts management when entitlements/benefits lapse, and assists management with reinstatement of discontinued benefits.
Qualifications
Licensure: Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.
Education: High School degree or equivalent required. Associate Degree in a healthcare related field preferred.
Experience: Minimum of two years of customer service experience required. Experience in a health care organization preferred. Proficiency in MS Word, Excel, and data systems required. General office experience including billing, accounts receivables and/or bookkeeping preferred. Bilingual skills may be required, as determined by regional/operational needs.
