Senior Member Service Representative (Hybrid)

Village Care•New York, NY

2d•Hybrid

About The Position

Under the direct supervision of the Supervisor of Member Services, the Senior Member Services Representative is responsible for handling all calls that come through our call center. The Senior Member Services Representative will handle more complex inquiries and grievances to serve as an escalation channel to the Member Service Representative. Responsible for assisting member in accessing services, solving problems and communicating with other members of the Interdisciplinary Care Team. Some daily responsibilities will include: Handles incoming telephone calls and answers questions for members and providers; assists members in accessing all necessary covered and non-covered services in conjunction with plan of care Handle and provide analytical research and resolution to escalation calls. Conducts post-enrollment orientation activities, including orientation of members, members' families or representatives Explains the plan's rules for obtaining services and assists members in making appointments with their primary care physician and other health care providers Responds to member questions and grievances; and advising members of the prerogative to complain to Department of Health or State designated entity at any time Clarifies information in the member handbook or VillageCareMAX website for members Advises members of the plan's grievance and appeals system, the services authorization process and the member's right to a fair hearing and/or external review; Log member and provider grievances; Resolves same day grievances where possible. Facilitates communications between members, subcontractors, providers and Care Managers Conducts medication reminder phone calls under the direction of the Interdisciplinary Care Team Assists member in selection of participating providers Assists the Interdisciplinary Care Team in performing non- clinical assessments Data enterers authorizations under the direction of the Interdisciplinary Care Team

Requirements

Associate degree is required; bachelor's degree is preferred.
Minimum of 3 years' job related experience in Health Care
Demonstrated experience with PC's and related software including Windows and Microsoft Office Suite
Bilingual - Spanish is required.

Nice To Haves

Experience with Managed Long Term Care and Medicare Dual Special Needs programs preferred

Responsibilities

Handles incoming telephone calls and answers questions for members and providers
Assists members in accessing all necessary covered and non-covered services in conjunction with plan of care
Handle and provide analytical research and resolution to escalation calls.
Conducts post-enrollment orientation activities, including orientation of members, members' families or representatives
Explains the plan's rules for obtaining services and assists members in making appointments with their primary care physician and other health care providers
Responds to member questions and grievances
Advising members of the prerogative to complain to Department of Health or State designated entity at any time
Clarifies information in the member handbook or VillageCareMAX website for members
Advises members of the plan's grievance and appeals system, the services authorization process and the member's right to a fair hearing and/or external review
Log member and provider grievances
Resolves same day grievances where possible.
Facilitates communications between members, subcontractors, providers and Care Managers
Conducts medication reminder phone calls under the direction of the Interdisciplinary Care Team
Assists member in selection of participating providers
Assists the Interdisciplinary Care Team in performing non- clinical assessments
Data enterers authorizations under the direction of the Interdisciplinary Care Team