Bilingual Member Service Rep II

About the role

The SCOPE OF POSITION involves maintaining knowledge of the Arkansas Medicaid program, providing customer service, resolving grievances and complaints, assisting in healthcare coverage issues, and coordinating with various components of the AR Medicaid program.

Responsibilities

• Coordinate communication between various components of the AR Medicaid program.
• Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment.
• Resolve customer/client requests including research, referral, policy review, revision and development, documentation and follow up in accordance with established policy/procedures.
• Communicate effectively with customers and/or recipients.
• Develop and maintain working relationships as necessary 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.
• Aid 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 to external customers for quality improvement and follow through for compliance of recommendations for improvement.
• Train and knowledge in all other areas of Members Services to assist as needed with the overall operation of the Member Services department.
• Aid PASSE Members in changing their initial auto-assignment to a PASSE entity, complete the change in the MMIS system and document all PASSE correspondence using the JIRA ticketing system.
• Maintain knowledge to efficiently function using Contractor’s software: MMIS, CURAM, JIRA ticket system, and ANSWER.
• Adhere to format, content and style guidelines, giving consideration to usability and 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.

Knowledge, Skills and Abilities

• 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
• 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 (With or Without the Aid of Mechanical Devices): 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/Spanish. 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.