Healthcare Organizational Operations Administrator - Complaint Intake

Staffing Solutions Organization LLC (SSO) • Albany, NY

56d

About The Position

The Healthcare Organizational Operations Administrator (HOOA) will assist the Unit Manager with the day-to-day activities associated with the Intake Unit, including but not limited to the receipt and intake of Medicaid enrollee and provider complaints and inquiries. This position will respond to and track all written, verbal, and electronic complaints and inquires made by enrollees, health care providers and their designees. These responsibilities include: Respond professionally to complaints and inquiries from the Bureau of Consumer Services (BCS) complaint phone line, fax and complaint email boxes. The HOOA will collect relevant information from the complainant and accurately enter the information into the BCS Complaint Database or refer caller to the responsible government agency. Use all available resources to accurately respond to allegations raised by complainants. Elevate complaints to the BCS Investigation Unit appropriately, ensuring all relevant information is included in the complaint file. Work collaboratively with health insurance plans, healthcare providers, consumers, advocates, designees and government agencies to ensure appropriate action is being taken and that the complainant understands their rights. Provide current and accurate guidance to complainants regarding Medicaid Managed Care services and benefits. Maintain an organized work environment to ensure work is accomplished efficiently and effectively. Support all work of the Intake Unit and assist in special projects as requested by the Team Lead or Unit Manager.

Requirements

• 3 years of administrative experience

Nice To Haves

• Associates Degree
• The ability to function in a team environment
• The ability to take initiative and ask questions
• The ability to speak professionally on the phone
• Call Center Experience
• Knowledge of NYS government sponsored health programs.
• Knowledge and experience using eMedNY (NYS Medicaid Eligibility System) and Back Office (NYSOH)
• Experience in investigating issues in enrollment and eligibility and Managed Care Plan regulatory compliance
• Knowledge of medical terms and procedures
• Proficiency in Microsoft Office (Excel)

Responsibilities

• Respond professionally to complaints and inquiries from the Bureau of Consumer Services (BCS) complaint phone line, fax and complaint email boxes. The HOOA will collect relevant information from the complainant and accurately enter the information into the BCS Complaint Database or refer caller to the responsible government agency.
• Use all available resources to accurately respond to allegations raised by complainants.
• Elevate complaints to the BCS Investigation Unit appropriately, ensuring all relevant information is included in the complaint file.
• Work collaboratively with health insurance plans, healthcare providers, consumers, advocates, designees and government agencies to ensure appropriate action is being taken and that the complainant understands their rights.
• Provide current and accurate guidance to complainants regarding Medicaid Managed Care services and benefits.
• Maintain an organized work environment to ensure work is accomplished efficiently and effectively.
• Support all work of the Intake Unit and assist in special projects as requested by the Team Lead or Unit Manager.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 11-50 employees