Key Responsibilities - Respond and effectively triage member phone calls in order to accurately and timely route to appropriate area - Work with care management team to address the needs of members, caregivers and other CCA constituents - Provide timely and accurate information regarding member benefits and services including Continuity of Care - Meticulously document all member and prospective member interactions in a Centralized Electronic System - Responsible for the scheduling of member appointments, transportation, translation and interpretation services - Initiates Prior Authorization Intake process - Attends to erroneous member billing discrepancies - Assist with member mailings and respond to questions about mailings - Responsible for providing members with any requested documents including provider listings in their areas - Complete comprehensive appeal and grievance intakes. - Assist with timely resolution of quandaries or complaints conveyed by member and members’ representative - Responsible for conducting in dept. research to provide accurate and informed resolution to members inquiries - Assist in the collection of supporting data and documentation relevant to member’s care - Serve as a facilitator connecting members to their CCA providers thru Telemedicine accessibility - Responsible for educating members on benefits and services available as well as protocols and requirements - Responsible for acting in compliance with HIPAA, State and Federal regulations when assisting CCA members - Responsible for meeting departmental expectations, benchmarks, goals and Key performance indicators - Other responsibilities and duties as assigned Expectations of all Employees Demonstrate integrity by working with passion, commitment, and honesty, acting in the best interests of colleagues and members. Demonstrate accountability by delivering on commitments and contributing to an empowering environment where the focus is on member satisfaction by providing best in class service. Recognize and respect diversity in all forms. Strive for excellence in the fulfillment of CCA’s mission through quality, innovation, and continuous learning. Represent CCA and its clinical affiliates with professionalism. Keep current and proficient with necessary skills and knowledge including technology. Adhere to all applicable compliance requirements such as CCA’s Policy & Procedures. Ensure confidentiality of member and company proprietary information is maintained
Minimum Education Required Associates Degree or Post High School Training/ Certification/ Education Required. Preferred Educational Experience An Associate or bachelor’s degree in any general or health-oriented fields is preferred. Also, experience in health care, the non-profit service sector, or government is preferred. Technical accreditation in the health care field (i.e. Medical Assistant | Billing and Coding) is a plus. Minimum Years’ Experience Required 1-3 years Minimum Experience Not less than one-year customer service experience. Knowledge, Skills and Abilities - Experience and competent in working with a diverse disabled and elderly population - Must be passionate about serving others and able to show empathy to distress individuals - Must have experience providing customer-focused service and activities - Experience working independently while in a team environment. - Skilled in problem solving by referencing departmental standard operating procedures and workflows. - Critical thinking and sound judgement - Prior experience working in the health care industry front lines or medical setting preferred - Prior experience working in a Call/Contact Center preferred - Must be resilient and adaptable working in an environment that includes continuous change - Experience working in a quality-focused environment with a rigorous quality assurance measuring program - Proven proficiency working in a metrics, benchmarks and goals driven in an active work environment. - Reliability and punctuality are a must - Computer literacy a must, demonstrated ability to work with multiple complex systems simultaneously - Ability to document information clearly and efficiently using medical terminology a must - Excellent interpersonal skills required and ability to interact professionally - Experience working in a diverse environment: socioeconomically, ethnically, and culturally - Capacity to kindly and respectfully assist all our constituents including irate and difficult callers, with the uppermost level of customer service. Preferred Previous Work Experience: Currently or recently employed in customer service, public service, as front-line health care worker, or in a contact center. Equipment Utilized - Standard Office Equipment - Remote Connectivity Equipment Language Requirements - Superb verbal and written communications skills in English required - Articulate and adept in medical terminology preferred - Test proven proficiency in at least one other language strongly preferred Physical Requirements - Ability to sit for long periods of time - Light lifting, and bending Working Conditions The MSR position requires the ability to sit at a desk, while talking on the telephone and using the computer, for eight hours each day. The position requires the ability to focus on own work while sitting at a desk cubicle in a Call Center. The position also requires light lifting and bending, while filing member records and similar. The position might require occasional travel to contracted provider sites.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Job Type: Temporary

Pay: $19.00 - $23.00 per hour

Application Question(s):

• Will you be able to reliably commute to our Cerritos, CA office?

Language:

• Please list any languages you speak and your proficiency (Preferred)

Shift availability:

• Day Shift (Required)
• Night Shift (Required)

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