Job description

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.
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: Part-time

Shift:

• Day shift
• Night shift

Weekly day range:

• Monday to Friday
• Weekend availability

Work setting:

• Remote

Application Question(s):

• As a condition of being hired, training will take place over the course of 4 weeks (Mon-Fri) that will consist of both remote training (home office), as well as onsite training in our Boston office from 8:30am-5:00pm. Do you agree to commit to this training schedule?

Education:

• Associate (Required)

Experience:

• Call center: 1 year (Required)

Language:

• Portuguese (Preferred)

Shift availability:

• Day Shift (Preferred)
• Night Shift (Preferred)

Work Location: Remote

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