RA Member Engagement Representative

SOUTHLAND CARE COORDINATION PARTNERS INC•Olympia Fields, IL

3d•Onsite

About The Position

The Clinical Risk Adjustment Program Member Engagement Representative engages health plan members and schedules Risk Adjustment appointments. This role involves professional communication with members via verbal, electronic, and text-based interactions to assist them with scheduling appointments with Nurse Practitioners (NPs). The representative will maintain accurate documentation in the electronic health record (EHR), document appointments, execute member referrals/concerns/grievances, and report critical member issues. The role also requires interaction with staff to optimize workflow efficiency, compliance with performance goals, and promotion of a positive company culture. Adherence to all SCCP Policies and Procedures, including information security and confidentiality, is mandatory. The position also emphasizes respect for diversity and participation in continuing education.

Requirements

High School Diploma or Equivalent Required.
Minimum of 2 years in a Customer Service Role Required.

Nice To Haves

Minimum of 1 year of Call Center Representative Experience Preferred.
Excellent verbal communication skills.
Ability to interact with health care professionals in a professional manner.
Computer Literate – Word, Google Doc and Excel.
Able to multi-task, manage time and set priorities.
Able to remain coachable and teachable at all times.

Responsibilities

Engage health plan members and employ professional techniques during verbal communications, electronic correspondence, and text-based interactions with each member.
Assist health plan Members with scheduling appointments with the Nurse Practitioners (NP’s).
Update and maintain accurate documentation of each member’s encounter in the electronic health record (EHR).
Accurately document appointments.
Properly execute member referrals/concerns/grievances when applicable.
Document timely member observations requiring administrative notification of any critical member issues/concerns.
Interact with staff and members to optimize workflow efficiency.
Compliant with Performance Goals / Contract Deliverables.
Help promote a company culture that encourages top performance and high morale.
Follow all Policies and Procedures of SCCP.
Participate in all SCCP mandatory and CMS regulatory training.
Attend all staff meetings – in person or via telephone (if unable to attend, responsible for knowledge of content).
Develop a comprehensive understanding of SCCP information security policies.
Abide by all SCCP information security policies, procedures, protocols, and practices.
Abide by principles and laws related to confidentiality.
Report information security risks when they are identified.
Participate in regular information security management trainings.
Demonstrate respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status).
Engage in continuing education and training for professional growth and development.
Other duties as assigned by Direct Report.