[Hiring] Member Service Representative II @AFMC

Role Description

Official Schedule after training: 9:00am - 5:30pm

SCOPE OF POSITION:

• Maintain knowledge of the Arkansas Medicaid program.
• Provide effective and efficient customer service to Medicaid Members for Arkansas Medicaid Program or Premium assistance programs.
• Respond to and resolve grievances and complaints; provide accurate and up-to-date information.
• Assist Members with enrollment in a qualified health plan using the ACCESS Arkansas portal.
• Assign or change PCPs at the request of Members.
• Assist Members seeking dental care coordination services by providing dental benefit information, finding a dentist or dental specialist, scheduling dental appointments, and arranging transportation.
• Assist eligible Medicaid Members in changing their assignment in managed care dental plans.
• Serve as subject matter expert on assigned contract deliverables.
• Document services rendered in the appropriate format and system as designated by AFMC.
• Support the organization’s mission, vision, and values by exhibiting behaviors of Honesty, Excellence, Accountability, Respect, and Teamwork.

ESSENTIAL JOB FUNCTIONS:

• Coordinate communication between various components of the AR Medicaid program.
• Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment.
• Responsible for the resolution of customer/client requests including research, referral, policy review, revision and development, documentation, and follow-up.
• Communicate effectively with customers and/or recipients.
• Develop and maintain working relationships to meet contract deliverables of specialty area project.
• Act as a resource to internal and external customers for information pertaining to specialty area focus.
• Work with Information Services department to coordinate system developments and customizations.
• Assist in the creation and maintenance of necessary reports/documents to track and report project information.
• Monitor specific items within the area of focus, provide recommendations/feedback for quality improvement.
• Training and knowledge in all other areas of Members Services to assist as needed.
• Assist PASSE Members in changing their initial auto-assignment to a PASSE entity.
• Maintain knowledge to efficiently function using Contractor’s software: MMIS, CURAM, JIRA ticket system, and ANSWER.
• Adhere to format, content and style guidelines, ensuring accuracy, consistency, and quality.
• Communicate needs and requests to other team members as appropriate.
• Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
• Adhere to AFMC Quality Standards of Excellence.
• Additional duties as assigned.

Qualifications

• Must possess intermediate level computer skills (Excel, Word, Power Point, and Outlook).
• Type 25 wpm.
• Exceptional skills in business English and spelling.
• Ability to maintain confidentiality.
• Strong oral and written communication skills.
• Creativity.
• Customer service skills.
• Ability to meet deadlines.
• Attention to detail.
• Flexibility.
• Ability to work collaboratively and independently to achieve stated goals.
• Initiative.
• Ability to relate professionally and positively with staff, business partners, customers, constituents, members, and the public.
• Ability to multitask.
• Ability to prioritize.
• Strong organizational skills.
• Problem-solving skills.
• Professionalism.
• Project management skills.
• Ability to read, interpret, and apply laws, rules, and regulations.
• Knowledge of quality improvement processes and techniques.
• Time management skills.
• Ability to work overtime as needed.

Requirements

• Physical and Sensory Requirements: Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress, and ability to travel as needed.
• Must be able to lift and transport 25 pounds.
• Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.

Education

• Required: High School Diploma.

Experience

• Bilingual English/Marshallese.
• Two (2) years’ experience within the healthcare arena, an understanding of Medicaid guidelines, customer relations, and call center experience.
• Desirable: Experience within the healthcare arena and understanding of the Medicaid Guidelines.

Internet Requirements

• Reliable, high-speed wireless internet service (Wi-Fi).
• An upload speed of at least 5Mbps is required to support softphone functionality.