Marshallese Member Service Representative II

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 in resolving issues or concerns about healthcare coverage; familiarize Members with enrollment in a qualified health plan by using the ACCESS Arkansas portal; assign or change PCPs at request of Members; assist Members who seek dental care coordination services by providing dental benefit information, finding a dentist or dental specialist, scheduling dental appointment, arranging transportation for the appointments; assist eligible Medicaid Members in changing their assignment in managed care dental plans.

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 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.
  
• 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.
  
• Prepare ad hoc reports and/or statistics as directed.
  
• 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.
  
• Daily quotas may be added to meet contract deliverables as needed.
  
• 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)
    
  • Exceptional skills in business English and spelling
    
  • 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
    
  • Strong organizational skills
    
  • Problem solving skills
    
  • Professionalism
    
  • Project management skills
    
  • Knowledge of quality improvement processes and techniques
    
  • Time management skills
    
  • Ability to work overtime as needed

    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
      
    • 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.