[Hiring] Customer Service Representative @Astrana Health, Inc.

Role Description

Astrana is looking for a Customer Service Representative to join our fast and growing Dynamic team. This position requires speaking fluent in Cantonese or Mandarin to assist with our member population.

What You'll Do

• Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents, and hospitals.
• Collect and elicit information from members/providers including the problem or concerns and provide general status information.
• Verify authorization, claims, eligibility, and status only.
• Document all calls carefully into the Company’s customer service module & NMM Queue system.
• Assist Supervisor and Manager with other duties as assigned.
• Conduct member outreach communications via mail or telephone.
• Assist members with appointments with providers.
• Resolve walk-in member concerns.
• Provide quality service to customers.
• Communicate effectively with customers in a professional and respectful manner.
• Maintain strictest confidentiality at all times.
• Send specialist termination notifications to members.
• Notify Medicare members of urgent Medicare authorization approvals.
• Arrange transportation for Medicare & Medi-Cal members.
• Handle outreach project assignments.

Inbound Calls

• Document all calls carefully into the Company’s customer service module.
• Manage Annual Wellness Visit (AWV) – Gift card pick up and schedules.
• Handle Appointment of Representative (AOR) for Medicare Members.
• Respond to attorney/third-party vendor calls.
• Provide authorization status/modification/redirection/CPT code changes/quantity adds/explain denied auth/peer to peer calls/extend expired auth/pre-certified auth status/retro/2nd or 3rd opinion.
• Conduct 3-way conference calls to Health Plan with members.
• Facilitate conference calls with providers – appointments, DME.
• Address COVID-19 related questions (tests & vaccines).
• Manage direct member reimbursements (DMR).
• Handle eligibility – demographic changes: address/phone/fax changes/name change.
• Manage escalated calls from providers/members.
• Assist with Health Diary Passport.
• Support Health Source MSO – assist & arrange inquiries on eligibility/change PCP/benefit with AHMC.
• Obtain member consent verification for HIPAA.
• Address inquiries on provider network/provider rosters.
• Manage lab locations inquiries.
• Handle member & provider complaints/grievances.
• Address member bills inquiries.
• Manage miscellaneous calls.
• Assist with pharmacy – drug/medication pick up and coverage.
• Provide authorization status for Hospital/CM Dept.
• Handle self-referral requests for Medicare.
• Manage return mail and track mail packages/certified mail status.
• Provide translations – Spanish/Chinese.
• Address urgent care/location/operations hours inquiries.

Outbound Calls

• Assist case management on CCS – age in 21 years for change of PCP from Pediatrics to FP/IM.
• Assist marketing on email inquiries.
• Assist PR/elig – members assigned to wrong PCP/with no PCP status.
• Assist UM/medical directors on urgent member appointments from escalated cases.
• Provide authorization status response call back.
• Return calls regarding benefits once information is obtained/verified.
• Return calls regarding complaints/grievances once resolution is obtained.
• Provide DME translation support in Spanish and Chinese to confirm item/appointment setup for DME department.
• Return calls to providers/labs when member is added to the system while waiting at the office.
• Return calls regarding member bills once resolution is obtained.
• Conduct member surveys annually: every 4th quarter.
• Handle outreach projects from internals – QCIT.
• Resolve walk-in member concerns.
• Send specialist termination notifications to members.
• Arrange transportation for Medicare/Medi-Cal members.
• Return calls to voicemails.

Concierge Services – Essential Duties and Requirements

• Assist in contacting new members/IPA member transfer on new PCP assignment as needed.
• Participate in group discussions on work status/progress on new member/IPA transfer.
• Update call log and provide daily/weekly status as needed.
• Facilitate members with complex pre-existing conditions, medications, PCP/SPC network reviews.
• Conduct conference calls with PCP selection/change.
• Help members identify bill status, connect providers with billing and claim submission.
• Responsible for the experience of the membership associated with new member/IPA transfer.
• Interact with Health Plan’s Customer Service Team to serve new member/IPA transfer.
• Problem-solve complex cases/brainstorm with MS management team for resolution.
• Perform other duties as assigned.

Qualifications

• High School Diploma or GED.
• Experience using Microsoft applications such as Word, Excel, and Outlook.
• Experience working in customer service.
• One year related experience and/or training; or equivalent combination of education and experience.
• Fluency in Cantonese or Mandarin.

Requirements

• Previous work experience in a healthcare setting is preferred.

Benefits

• This is a remote role.
• The position requires working between Monday - Friday at 8:30 am to 5:00 pm PST.
• The target pay range for this role is $17.50 - $22.00 per hour.
• Actual compensation will be determined based on geographic location, experience, and other job-related factors.

Company Description

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.

If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.