About the Role: Astrana is looking for a Customer Service Representative to join our fast and growing Dynamic team.
What You'll Do
- Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals
- Collect Elicit information from members/providers including the problem or concerns and provide general status information
- Verify authorization, claims, eligibility, and status only
- All calls carefully documented into Company’s customer service module & NMM Queue system
- Member/Provider Service/Representative assists Supervisor and Manager with other duties as assigned
- Member outreach communications via mail or telephone
- Assist Member appointment with providers
- Resolve walk-in member concerns
- Able to provide quality service to the customers
- Able to communicate effectively with customers in a professional and respectful manner
- Maintain strictest confidentiality at all times
- Specialist termination notifications sent to members
- Urgent Medicare Authorization Approval – Notification to Medicare members
- Transportation arrangement for Medicare & Medi-Cal members
- Outreach Project Assignments
INBOUND CALLS:
- Member/Provider/Health Plan/Vendor/Hospital/Broker:
- All calls carefully documented into Company’s customer service module
- Annual Wellness Visit (AWV) – Gift card pick up and schedules
- Appointment of Representative (AOR) for Medicare Members
- Attorney / Third Party Vendor calls
- Authorization status/Modification/Redirection/CPT Code changes/Quantity adds/Explain Denied Auth/Peer to Peer calls/Extend expired auth/Pre-certified auth status/Retro/2ndor 3rd opinion/
- Conduct 3 way conference call to Health Plan with member
- Conference call with Providers – Appointments, DME,
- COVID – 19 related questions (Tests & Vaccines)
- Direct Member Reimbursement (DMR)
- Eligibility – Demographic changes: Address/Phone/Fax Changes/Name change
- Escalated calls from providers/members
- Health Diary Passport
- Health Source MSO – Assist & arrange inquiries on Eligibility/Change PCP/Benefit with AHMC
- HIPPA Consent – Obtain Member Consent verification
- Inquiries on provider network/provider rosters
- Lab locations
- Member & Provider Complaints/Grievances
- Member bills
- Miscellaneous calls
- Pharmacy – Drug/medication pick up and coverage
- Provide authorization status for Hospital /CM Dept
- Self-Referral Request for Medicare
- Return Mail
- Track Mail Packages/ Certified mail status
- Translations – Spanish / Chinese
- Urgent Care / locations/ operations hours
OUTBOUND CALLS:
Member/Provider/Health Plan/Vendor/Hospital/Broker:
- Assist Case Management on CCS – age in 21 years for change of PCP from Pediatrics to FP/IM
- Assist Marketing on email inquiries
- Assist PR/ Elig – Members assigned to wrong PCP/with no PCP status
- Assisted UM / Medical Directors on urgent member appointment from escalated cases
- Authorization status response call back
- Benefits – return call once information is obtained / verified
- Complaints/Grievances – return calls once resolution is obtained
- DME – Translation support in Spanish and Chinese to confirm item / appointment set up for DME department
- Eligibility – return call to providers/labs when member is added to system while waiting at the office.
- Member bills – return calls once resolution is obtained
- Member Survey – Annually: every 4thquarter
- Outreach project from internals – QCIT
- Resolve walk in members concerns
- Specialist Termination notification sent to members
- Transportation arrangement for Medicare / Medi-Cal members
- Voice mail – return calls back to callers
CONCIERGE SERVICES – ESSENTIALS DUTIES AND REQUIREMENTS:
- Assist to contact new members/IPA member transfer on new PCP assignment as needed
- Work group discussions on work status/progress on new member/IPA transfer
- Update call log and provide daily/weekly status as needed
- Facilitate members with complex pre-existing conditions, medications, PCP/SPC network reviews
- Conference call with PCP selection / change
- Help member to identify member bill status, connect provider with on billing and claim submission
- Responsible for experience of the membership associated with new member/IPA transfer
- Responsible for to interact with Health Plan’s Customer Service Team to serve new member/IPA transfer
- Problem Solving complex cases/ brain storm with MS management team for resolution
Qualifications
- High School Diploma or GED
- Experience using Microsoft applications such as Word, Excel and Outlook
- Experience working in customer service
- One year related experience and/or training; or equivalent combination of education and experience
- You are fluent in Mandarin or Cantonese
You're a great for this role if:
- You have previous work experience working in a healthcare setting
Environmental Job Requirements and Working Conditions
- This is a remote role. The home office is aligned with your department at 9700 Flair Drive, El Monte, CA 91731
- This position will typically work Monday - Friday from 8:30am to 5:00pm PST.
- The target pay range for this role is $20.00. This salary range represents national target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change
