Care Connector

About the Role

AmeriHealth Caritas is seeking talented, passionate individuals to join our team and help build healthier communities. As one of the nation's leaders in health care solutions, we offer associates the opportunity to impact the lives of millions through our national footprint of products, services, and award-winning programs. This role is based in the Washington, D.C. area and supports our mission-driven organization with over 30 years of experience delivering comprehensive, outcomes-driven care.

Responsibilities

• Provide select program interventions according to established health management program guidelines for the Member population under the direction of the designated Supervisor/Manager.
• Screen identified Members based on Plan stratification for the program, interacting with Members, providers, and other AmeriHealth Caritas staff to implement interventions and document activities.
• Refer risk-appropriate Members to professional/licensed staff according to protocols and support program interventions of the care management department.
• Utilize communication and listening skills, including Motivational Interviewing, to conduct inbound and outreach calls, and collect data according to scripts.
• Use scripts, tools, and protocols to meet productivity and performance expectations.
• Perform process calls from Members, providers, and other internal/external departments.
• Elicit information from Members through surveys and questionnaires to identify Care Gaps, HEDIS-related health conditions, and social determinants of health needs.
• Assist Members in accessing care through health plan benefits and community resources, providing educational materials and strategies to increase adherence to treatment.
• Support Members with non-clinical functions such as identifying and linking to community resources and scheduling appointments.
• Perform research using the internet and processed claims to identify alternate contact information for providers, pharmacies, and care team members.
• Maintain timely, complete, and accurate documentation of Member interactions in the electronic care management platform.
• Develop working knowledge of policies, standard operating procedures, workflows, Member insurance products and benefits, NCQA and regulatory requirements, community resources, and Electronic Visit Verification system.
• Support daily workflows with an emphasis on a positive workplace environment through concise and timely interactions with staff, facilities, vendors, and providers.
• Process, maintain, and close incoming/outgoing correspondences/faxes in accordance with required standards and timeliness guidelines.
• Refer calls to appropriate clinical team members as defined by workflow and triage calls from Members and providers.
• Process urgent scanning, mailing requests, and documentation retrieval as applicable.
• Demonstrate professional and courteous communication, complying with ACFC and HIPAA confidentiality standards.
• Adhere to ACFC Policies & Procedures, process standards, and Standard Operating Procedures while maintaining current knowledge of Member benefits, rights, and responsibilities.
• Perform other related duties and projects as assigned within identified timeframes.

Requirements

• High School Diploma or GED required; Associate degree preferred.
• Minimum of 2 years of work experience in a healthcare environment.
• Minimum of 1 year of telephonic customer service experience, preferably within a healthcare setting.
• Medical terminology experience preferred.
• Training and/or certification as a medical assistant, home health aide, nursing assistant, or other similar health care paraprofessional preferred.
• Excellent interpersonal and communication (listening, verbal, and written) skills, including the ability to keep accurate and timely records.
• Proficiency in MS Office (Word, Excel, Outlook, Teams), SharePoint, and Windows-based environments preferred.
• Experience working within electronic medical record database programs preferred.
• Must reside in the Washington, D.C. area.
• For 100% remote or hybrid roles, access to a reliable high-speed internet connection (minimum 50 Mbps download and 5 Mbps upload) is required. Reimbursement may be available for associates in states where service is contractually required.

Additional Qualifications

To provide our Members with the best experience, we look for employees who can communicate in their preferred spoken language. In addition to English, the following are our Members' most common languages: Spanish, Arabic, Haitian/Creole, Russian, Mandarin, and Vietnamese.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents starting on Day 1.
• 401(k) retirement plan.
• Tuition reimbursement.