Customer Care Associate II (Bi-lingual , Spanish, Chinese, Vietnamese) (Full Time)
Select Company:: Community Health Center Network
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 and Anthem Blue Cross. 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 II
Department:Customer Care
Reports To:Customer Care Supervisor
Classification: Non- Exempt
Status: Full Time (Regular)
POSITION SUMMARY
The Customer Care Associate II (CCA2) is responsible for providing centralized customer service to providers and members by accurately responding to basic and complex questions. Act as the subject matter expert by responding to inquiries and conduct in-depth research about CHCN procedures, operational policies, and transactions; resolving difficult issues and carrying out call tracking and supporting documentation from callers and staff. The CCA2 also supports an additional operational department, such as Provider Services, Claims, and Utilization Management Department in an outreach and support capacity serving as the first point of contact for our providers.
ESSENTIAL POSITION RESULTS
The 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, web portal issues, and provider services.
Perform caller requested research, including faxing authorization letters and EOBs.
Handle complex issues from providers and members alike that require additional research and/or contacting other groups for resolution.
Provide assistance to less experienced customer care staff and provide training on best practices
Ensure that CCA2 assigned daily tasks are completed in a timely manner. These include but are not limited to:
oThird Party Liabilities (TPL) from law firms/court subpoenas
oHeath Plan Grievances and Appeals research, documenting and tracking
oRemote Access Support
oTracking reasons for claim denial and communicating reasons to providers regularly to prevent erroneous submission.
Accurately update and document EZ-CAP Customer Service records with all information pertaining to more complex inquiries as well as all calls.
Recommend changes in Customer Care Unit operations, policy, procedures and workflow patterns based on observations, experience, and data.
Serve as the first point of contact for providers and vendors acting as triage for inbound inquiries regarding provider services.
Research and resolve caller problems, acting as the liaison between other CHCN departments when necessary
Promote the usage of CHCNs Connect Portal and provide procedural support for existing users via phone and in person.
Assist Provider Services department in contacting contracted providers to coach and educate on Connect Portal.
Communicate with contracted providers on a regular basis to provide training and answer questions related to the ongoing improvement/add-ons to Connect.
Foster productive working relationships with provider office staff to improve communication or flow of information.
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.
Consistently utilize multiple resources to resolve inquiries while on the phone.
Follow through on customer issues promptly and accurately until completion.
Independently complete daily assignment(s) and work towards department metric goals with little to no supervision
SUPERVISORY RESPONSIBILITIES
None
MINIMUM QUALIFICATIONS
Required Skills and Experience
13 years experience of commonly used customer service concepts, practices, and procedures
Ability to create a satisfied customer experience through energetic, passionate attention to the customer experience
Ability to guide and manage a customer call.
Ability to summarize customer issues and identify paths to solutions.
Ability to answer 100-120 inbound calls per day from members, providers offices, health plans and other external customers
Ability to learn and implement new ideas, processes, procedures quickly
Ability to work collaboratively within a team
Ability to communicate effectively both orally and in writing.
Drivers License & vehicle required to travel to off-site providers
Desired Experience
Bi-lingual in Spanish, Cantonese, or Vietnamese
Healthcare background working with MSOs, or medical billing a plus
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.
Mental and Physical Demands
Pace of Work: Rapid
Concentration: High level required, coordinating multiple program tasks.
Standing Time required: 10-15%, includes walking around
Time Speaking and listening: 85%-90%, mainly communicating with external customers and staff.
CERTIFICATES AND/OR LICENSES
High school diploma or equivalent required, 2-year college degree preferred.
PHYSICAL DEMANDS
The 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 25 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.
WORKING CONDITIONS AND ENVIRONMENT
The 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 and outside environment.
The Community Health Center Network is an Equal Opportunity Employer.
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