Quality Retention Specialist (Required to work PST hours and live in North Carolina)

Alignment Health • Davidson, NC

1d • $38,569 - $57,853 • Remote

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Quality Retention Specialist supports our members in their disenrollment requests and related quality assurance. Acts in a customer-focused manner and is genuinely interested in the needs of our members. Address’ various customer-related needs and be able to problem-solve and effectively resolve call escalations.

Requirements

• 1+ year of healthcare experience.
• 1+ year experience with Medi-Cal, Commercial, and Medicare Managed Care Plans and/or Sales, Customer Service, or Membership and Eligibility.
• High School Diploma or GED.
• Bachelor's degree or four years additional experience in lieu of education.
• Solid knowledge and understanding of the Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines.
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Ability to troubleshoot/problem solve.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees of the organization.
• Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s.
• Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Ability to apply common sense understanding to carry out detailed, but un-involved written or oral instructions.
• Ability to deal with problems involving a few concrete variables in standardized situations.
• Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• None

Nice To Haves

• Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations, medical prescription drug, and supplemental benefits preferred.
• MBA
• Bilingual in one of the following Spanish, Vietnamese, Mandarin, Cantonese, or Korean
• Sales License or completion of Alignment Health Plan sales certification a plus.

Responsibilities

• Serves as a “subject matter expert” in escalated member calls at risk of disenrollment and be able to resolve these escalations based on level of understanding/experience of healthcare, processes and protocols (i.e. authorizations, claims, provider network issues).
• Identifies process improvement opportunities within the Member Engagement department given the collaboration with different departments.
• Responsible for meeting and exceeding monthly goals as assigned.
• Acts as a subject matter expert in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries.
• Conducts outbound phone calls and/or receiving inbound phone calls within the department’s goal timeframe; successfully contact and adapt to the member’s communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and/or utilize interpreter service as needed.
• Collaborates with our partners – including but not limited to other departments, supplemental benefit vendors, and provider networks – to facilitate the member experience.
• Shares best practices and participating in team meetings or training as required.
• Provides outbound support for PCP/IPA terminations.
• Ensures that information and assistance provided is within the standards established by all applicable federal/state laws and regulations and health plan compliance.
• Responsible for real-time documentation and timely wrap-up to support outcomes reporting in all systems/applications as required; must enter member demographics and information with accuracy and attention to detail and ensure high quality of our organizational data.
• Participates in required team meetings and trainings, and exhibit satisfactory understanding of new information and process related to the company, health plan benefit packages, and Centers for Medicare and Medicaid Services (CMS)
• Assists with the development and training of new hires including shadowing.
• Supports other projects and duties as assigned.

Benefits

• Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED