Bilingual Member Service Rep II or Member Service Rep II

AFMC•Little Rock, AR

13d

About The Position

SCOPE OF POSITION: Maintain knowledge of the Arkansas Medicaid program, provide effective and efficient customer service to Medicaid Members for Arkansas Medicaid Program or Premium assistance programs. Maintain knowledge to respond to and resolve grievances and complaints; provide accurate and up to date information, and to assist in resolving issues or concerns about healthcare coverage; ability to familiarize Members with enrollment in a qualified health plan by using the ACCESS Arkansas portal; assign or change PCPs at request of Members; ability to assist Members who seek dental care coordination services by providing dental benefit information, finding a dentist or dental specialist, scheduling dental appointment, arranging transportation for the appointments; ability to assist eligible Medicaid Members in changing their assignment in managed care dental plans. Service as subject matter expert on assigned contract deliverables. Document services rendered in the appropriate format and in the appropriate system as designated by AFMC and provide reporting as required. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence, Accountability, Respect and Teamwork.

Requirements

Must possess intermediate level computer skills (Excel, Word, Power Point and Outlook)
Type 25 wpm
Exceptional skills in business English and spelling
Ability to maintain confidentiality
Strong oral and written communication skills
Creativity
Customer service
Ability to meet deadlines
Attention to detail
Flexibility
Ability to work collaboratively and independently to achieve stated goals
Initiative
Ability to relate professionally and positively with staff, business partners, customers, constituents, members and the public
Ability to multitask
Ability to prioritize
Strong organizational skills
Problem solving skills
Professionalism
Project management skills
Ability to read, interpret and apply laws, rules and regulations
Knowledge of quality improvement processes and techniques
Time management skills
Ability to work overtime as needed
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed.
Must be able to lift and transport 25 pounds.
Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.
High School Diploma
Two (2) years’ experience within the healthcare arena, an understanding of Medicaid guidelines, customer relations, and call center experience.
Reliable, high-speed wireless internet service (Wi-Fi)
An upload speed of at least 5Mbps is required to support softphone functionality.

Nice To Haves

Experience within the healthcare arena and understanding of the Medicaid Guidelines
Bilingual English/Spanish

Responsibilities

Coordinate communication between various components of the AR Medicaid program.
Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment.
Responsible for the resolution of customer/client requests including research, referral, policy review, revision and development, documentation and follow up in accordance with established policy/procedures.
Communicate effectively with customers and/or recipients.
Develop and maintain working relationships as necessary to meet contract deliverables of specialty area project.
Act as a resource to internal and external customers for information pertaining to specialty area focus.
Work with Information Services department to coordinate system developments and customizations.
Assist in the creation and maintenance of necessary reports/documents to track and report project information.
Prepare ad hoc reports and/or statistics as directed.
Monitor specific items within the area of focus, provide recommendations/feedback to external customers for quality improvement and follow through for compliance of recommendations for improvement.
Training and knowledge in all other areas of Members Services to assist as needed with the overall operation of the Member Services department.
Assist PASSE Members in changing their initial auto-assignment to a PASSE entity, complete the change in the MMIS system and document all PASSE correspondence using the JIRA ticketing system.
Maintain knowledge to efficiently function using Contractor’s software: MMIS, CURAM, JIRA ticket system, and ANSWER.
Daily quotas may be added to meet contract deliverables as needed.
Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
Communicate needs and requests to other team members as appropriate.
Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
Adhere to AFMC Quality Standards of Excellence.
Additional duties as assigned.