Member Assessment Agent (Bilingual Tagalog)

Responsibilities

Responsible for conducting member assessments, educating members of plan benefits, and connecting members to community partner agencies and other community resources. The agent will work closely with various departments within HPMS to ensure regulatory compliance.

• Coverage of member assessment interviews and collection of members' health history, primarily by phone.
• Clear documentation of responses, risks, and any barriers to accessing proper care in HPSM systems.
• Verification of receipt and validation of completion of member assessments received via various methods.
• Confirmation of member eligibility and special flag status, such as hospice status.
• Exhausting all resources and making robust outreach attempts to follow up on open cases, including conducting member outreach by mail.
• Clear documentation of any member complaints, including grievances and appeals.
• Validation, research, and reconciliation of discrepancies identified through various HPSM systems like HEALTHsuite, and updating member demographics as needed.
• Clear referral and communication of pertinent health information to appropriate departments to facilitate assistance with the member.
• Participation in team meetings and contribution to quality improvement initiatives.
• Escalation of member issues to Member Assessment Supervisor as appropriate.

Qualifications

Education and experience equivalent to: Equivalent to a high school diploma or GED required. Minimum of two (2) years of work experience in a healthcare or managed care environment. Experience working in a call center environment highly preferred.

• Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Medicare and Medi-Cal programs highly preferred. Best practices in customer service, especially telephone-based services.

Abilities: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks. Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds. Participate in problem research, use analytical skills, and effectively influence positive outcomes. Develop and maintain strong professional relationships with a diverse range of people. Utilize a personal computer including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook). Use initiative, work independently, and make sound judgments. Work under pressure and within strict timeframes. Interact well with a variety of people and work effectively as part of a cross-functional team.

Desirable Skills: Bilingual skills in Spanish, Tagalog, Mandarin, or Cantonese.

Pay, Benefits, and Schedule

The starting salary range is $26.56 - $33.59 per hour, depending on the candidate’s work experience. Excellent benefits package includes: HPSM-paid premiums for employees’ medical, dental and vision coverage (employee pays 10% of each dependent’s premiums), Fully paid life, AD&D and LTD insurance, Retirement plan (HPSM contributes the equivalent of 10% annual compensation), 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year, Tuition reimbursement plan, Employee wellness program.