Remote
Job Description
General Description
Responsible for conducting member assessments, educating members of plan benefits, and connecting members to community partner agencies and other community resources. The agent will work closely with various departments within HPMS to ensure regulatory compliance.
Duties & Responsibilities
Essential Functions:
- Conduct member assessment interviews and collect members’ health history, primarily by phone.
- Clearly document responses, risks, and any barriers to accessing proper care in HPSM systems.
- Confirm receipt and validate completion of member assessments received via mail, telephone, fax, email, in-person, online, and external partners.
- Confirm member eligibility and special flag status, e.g., hospice status.
- Exhaust all resources and make robust outreach attempts to follow-up on open cases, including conducting member outreach by mail.
- Clearly document any member’s complaints, including grievances and appeals.
- Validate, research, and reconcile any discrepancies identified through various HPSM systems such as HEALTHsuite, and update member demographics as needed.
- Clearly refer and communicate pertinent health information to appropriate departments to facilitate assistance with the member.
- Participate in team meetings and contribute to quality improvement initiatives.
- Escalate member issues to Member Assessment Supervisor as appropriate.
Secondary Functions:
- Perform other duties as assigned.
Qualifications
The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position:
Education and experience equivalent to:
- Equivalent to a high school diploma or GED required.
- Minimum of two (2) years of work experience in a healthcare or managed care environment.
- Experience working in a call center environment highly preferred.
Knowledge of:
- Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
- Medicare and Medi-Cal programs highly preferred.
- Best practices in customer service, especially telephone-based services.
Abilities:
- Work cooperatively with others.
- Work as part of a team and support team decisions.
- Communicate effectively, both verbally and in writing.
- Adapt to changes in requirements/priorities for daily and specialized tasks.
- Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
- Perform problem research, use analytical skills, and effectively influence positive outcomes.
- Develop and maintain strong professional relationships with a diverse range of people.
- Utilize a personal computer including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).
- Use initiative, work independently, and make sound judgments.
- Work under pressure and within strict timeframes.
- Interact well with a variety of people and work effectively as part of a cross functional team.
Desirable Skills
- Bilingual skills in Spanish, Tagalog, Mandarin, or Cantonese.
Salary and benefits
The starting salary range is $25.78 - $32.61 per hour, depending on the candidate’s work experience.
Excellent benefits package includes:
- HPSM-paid premiums for employees’ medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
- Fully paid life, AD&D and LTD insurance
- Retirement plan (HPSM contributes the equivalent of 10% annual compensation)
- 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
- Tuition reimbursement plan.
- Employee wellness program
It is HPSM's policy to provide equal employment opportunities for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.
