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MEMBER SERVICES REPRESENTATIVE

Company: Hoag Memorial Hospital Presbyterian
Location: Costa Mesa
Posted on: May 3, 2021

Job Description:

Job DescriptionThe Member Advocate Level serves our patients, members, and providers to facilitate the delivery of healthcare acting as an ambassador on behalf of the member. In a call center work-environment, the Member Advocate deploys empathy, problem-solving skills and perseverance to exceed the expectations of its customers and partners. Member Advocates respond to all member and provider inquiries delivering top-caliber concierge service through multiple communication channels. With the assistance of data and technology, member advocates guide members through scheduling, benefits and care services to ensure a high value and personalized experience. This role is central to ensure a uniquely Hoag experience and a successful journey through the healthcare system. Member advocates operate in a continual learning experience empowered to self-correct and influence process improvement and technology improvement. Level II and aboveMember Advocate Level II develops a specialized expertise in a specific domain (Health Plan benefits, Provider Disputes, Professional chat etiquette guidelines, etc.). The Level II advocate has a high proficiency to address complex issues with claims and referrals. The Level II advocate will also perform outreach calls to assist with wellness activities. Level IIIMember Advocate Level III is a mentor on the team that leads aspects of the training function, is a subject matter expert in a variety of knowledge sets, and effectively handles service recovery functions, and is a change agent for service delivery and process improvement activities. Essential Functions:Respond to the inbound member and provider and healthcare entity communications (call, text, email, chat, etc.) adhering to designated protocols and service responses while providing exceptional customer serviceAssist in cases requiring additional non-clinical follow-up and care coordination, including, but not limited to: enrollment and eligibility, scheduling appointments, plan benefits, claims, referrals provider network inquiries, care management program assistance, and obtaining ancillary results and medical recordsCommunicate and collaborate with interdisciplinary teams; when needed ensure effective soft transfers with utilization management, clinical care, and wellness teamsAccurately collects and documents the appropriate level of information to facilitate resolution and identify trendsFunction as a detective to find creative solutions to difficult problemsEnsure problem resolution or smoothly transition to a higher level advocate or manager when appropriateParticipate in process improvement activities by openly sharing thoughts, ideas and constructive feedback to technical, Hoag experience, and management steamsRecognizes the presence of patient issues that may require immediate clinical assessment or action, based on BLS training and the Red Flag List, and notifies clinical staffMay assemble and send new patient packets, registration packets, and history/physical forms prior to scheduled appointments.Responds appropriately to inquiries and complaints. Can troubleshoot and problem solve independently as situations occurEnsures adherence to daily operating metrics systemsOther duties and projects as assigned Level II and aboveOutreach to members and patients to facilitate onboarding; persuade participation in wellness and health promotion activities such as ensuring effective transitions of care; arranging for completion of gaps in care, scheduling annual wellness visit; and to communicate authorization approvals and denials within required time framesMasters a specialized skill and assist with the education and training of peersAssist with organizing topics for daily team huddles and meetings and ensure follow-ups and action items are captured and assignedOther duties and projects as assignedLevel IIIServe as a role model for Member Advocate team adhering to the Hoag values, assisting with onboarding, training and coaching.Serves as a source for ideation and process redesign effectively championing new workflows, new technology in automation and decision supportCo-manage cases with nurses and social workers, ensuring all assigned tasks are completed on timeEnsure problem resolution and participate in service recovery activities when appropriateOther duties and projects as assigned Education, Training and ExperienceRequired:Level IHigh School Diploma or equivalent3 years of customer service experience in any industry Or meets all requirements in Level II or Level III. Level II and aboveAssociates degree or higher OR obtaining a bachelors degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse OR other professional clinical certification. Equivalent years of relevant experience will be considered in lieu of education.2 years of experience within a call center or healthcare setting with direct patient interaction.Level IIIBachelors degree or obtaining a bachelors degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse. Equivalent years of relevant experience will be considered in lieu of education.Previous work experience working as a care coordinator, member advocate, or health care unit coordinator or similar health related job function. Preferred:Level IIBachelors degree or obtaining a bachelors degree in healthcare related field OR certified medical assistant OR Licensed Vocational NursePrevious work experience working as a care coordinator, member advocate, or health care unit coordinator Level IIICertified Medical Interpreter Skills or Other QualificationsRequired:Level IIIPassionate, excited, and carry a positive attitude; a strong desire to simplify healthcareExperience in providing excellent customer service and have a heighten the empathetic abilitySkills to multi-task and manage competing priorities can triage appropriately and can apply critical thinking to solve problemsTech savvy and possess a capability to quickly learn new applicationsAbility to maintain composure and compassion while addressing a high volume of competing tasksComfortable with ambiguity and open to collaborative environmentsStrong moral compass and commitment to Hoags valuesMotivated to learn, continually improve and operate to ones fullest potentialBilingual skills (preferred) License and CertificationsRequired: NonePreferred: Level IIICertified medical assistant OR Licensed Vocational Nurse (LVN), Certified Medical Interpreter

Keywords: Hoag Memorial Hospital Presbyterian, Costa Mesa , MEMBER SERVICES REPRESENTATIVE, Other , Costa Mesa, California

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