Specialty Health Customer Support Specialist

TX-HHSC-DSHS-DFPS • Austin, TX

20h

About The Position

Under the general direction of the Specialty Health Customer Support Supervisor, performs highly complex (senior-level) eligibility activities for the Kidney Health Care (KHC), Children with Special Health Care Needs (CSHCN) Services Program, and the Hemophilia Assistance Program (HAP). This position performs client record updates that may or may not impact eligibility for the programs, and responds to inquiries received on the customer service toll free and local area phone lines as well as by mail, email, and fax. This position resolves complaints and escalates issues as necessary; consults with program staff on policies, practices, records and community resources. Responds to inquiries regarding eligibility determination of benefits. Documents case records to maintain accurate and confidential client records. Works under minimal supervision, with considerable latitude for the use of initiative and independent judgment.

Requirements

• Knowledge of state and federal program eligibility guidelines, regulations, and policies; social services eligibility requirements; and community welfare resources.
• Knowledge of programs which support client populations served by Specialty Health.
• Knowledge of benefits and eligibility determination processes.
• Knowledge of individual healthcare needs associated with special health care needs/disabilities and related community-based resources.
• Skill in interviewing, in conducting individual needs assessments, and in the use of a computer and applicable software.
• Skills in providing customer service to a wide range of customers, including patients, providers, and the public.
• Skill in providing technical assistance to providers, clients, and professional staff.
• Skills in using multiple manual and automated systems to support business processes.
• Skill in navigating and interpreting interagency policies and procedures.
• Skill in the use of Microsoft Office products.
• Skill in customer service support via phone and email correspondence.
• Ability to work and communicate effectively as a team member and in work groups.
• Ability to communicate verbally and in writing in an effective, tactful, and diplomatic manner.
• Ability to work under pressure and manage multiple assignments with minimal supervision.
• Ability to develop and interpret policies and procedures specific to customer service delivery
• Ability to respond to customer complaints in a professional and courteous manner.
• Ability to appropriately convey instructions and provide supportive feedback to clients and interested parties.
• Ability to maintain effective working relationships, to elicit and evaluate information, to research and investigate, to perform basic arithmetic and data analysis, and to communicate effectively.
• At least three years’ experience in customer service or administrative support work within a health and human services field.
• Experience providing customer support in a call-center environment.
• Experience in social services, financial eligibility determination, or investigative work.

Nice To Haves

• Fluent in both English and Spanish.
• Experience with Medicare, Medicaid, and CHIP regulations relating to eligibility, coordination of benefits, insurance, and third party coverage.
• Skills in providing quality customer service to clients and providers regarding complex eligibility requirements and benefits.

Responsibilities

• SH Program Guidance and Information UpdatesProvides accurate program specific information and performs client record update activities for eligibility determination for Specialty Health programs including KHC, CSHCN and HAP.
• Responds to requests for program information and updates received primarily through the customer service phone lines, and those received by fax, mail and/or email for all programs within office.
• Responds to high call volumes.
• Responds to information requests, inquiries and updates received from the recipients, providers, other agencies, and the public.
• Handles difficult, sensitive or escalated customer cases requiring advanced judgment and problem-solving.
• Communicates application status or travel reimbursement status clearly, while ensuring customers understand next steps, rights and responsibilities.
• Provides referrals for additional services when customer needs extend beyond SH.
• Works with supervisors, other team members and SH Eligibility team to coordinate services and ensure client, social worker and case manager communication and guidance is current, accurate, professional and helpful.
• Participate in team meetings, trainings and continuous improvement initiatives.
• Maintain precise documentation of actions for KHC, CSHCN and HAP clients in agency systems, ensuring all data is complete and compliant for eligibility determinations, verifications and payment processing.
• Serve as a primary subject matter expert to internal and external customers and other stakeholders on program eligibility guidance and program processes.
• Assist all stakeholders in understanding SH eligibility rules and requirements, travel reimbursement processes, and client record update processes.
• Other duties as assigned

Benefits

• Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed