Job Summary: The Medical Contact Center Care Coordinator II is responsible for providing outstanding customer service and support to members, caregivers, and healthcare professionals who contact our medical center. This role involves effectively managing inbound and outbound calls, emails, and other communication channels, to efficiently assist members in accessing healthcare services, scheduling appointments, and addressing inquiries regarding medical procedures, billing, and general information enrollment, eligibility, provider network authorization, plan guidelines and processes. Working across departments/functions to expedite resolution and to eliminate further escalation resulting in a complaint or grievance.

" Explains GCHP procedures, protocols, benefits, services and information to members as required.
Provides accurate information about eligibility, benefits and claim status and authorization requirements to serve members in a courteous and professional manner.
Functions efficiently and productively in all required duties.
Handles and resolves escalated issues.
Maintains an up-to-date and thorough knowledge of GCHP guidelines.
Provides accurate research to resolve issues regarding eligibility, benefits, claims and authorizations using appropriate systems.
Properly documents all calls/contacts as required by department standards in a timely, clear and concise manner using GCHP's internal in person tracking system.
Provides onsite assistance with member-oriented event as needed.
Reviews training/educational material and seek clarification when needed.
Maintains strict confidentiality of all sensitive information.
Refers unresolved issues to the next level and/or appropriate area when necessary.
Achieves and maintain acceptable performance levels according to the Member Service standards.
Utilizes documents using Microsoft Office and other applicable software, as designated by management.
Performs general clerical duties to include but not limited to photocopying, faxing, mailing, and filing.
Processes member ID card requests and performs other Member Services related tasks, functions and special projects.
Handle incoming calls, emails, and other communication channels promptly and professionally.
Assist members and caregivers in scheduling appointments, coordinating referrals, and navigating healthcare services.
Provide accurate and up-to-date information about medical procedures, services, and facilities.
Address member inquiries regarding billing, insurance coverage, and financial assistance programs.
Collaborate with healthcare providers and internal teams to ensure efficient and accurate communication of member needs and information.
Document member interactions, maintain accurate records, and update patient information in the system/database.
Follow established protocols and guidelines to escalate urgent matters or complex issues to appropriate personnel.
Adhere to compliance standards, confidentiality, and data protection regulations in all interactions and communications.
Participate in training sessions to stay updated on medical procedures, services, and changes in healthcare policies.
Strive to achieve key performance indicators (metric goals) related to call handling, customer satisfaction, and service quality.
Responds to internal and external requests for information within scope of assigned responsibility and departmental guidelines.
Ability to work independently and have strong organization and planning skills.
Consistently above QA/FCR/production goals with high degree of accuracy.
High level of proficiency with multiple GCHP system i.e. CRM/HealthEdge and MS Office suite such as Excel, Word, Teams, Outlook.
Ability to adapt to different healthcare market segments.
Coordinates and/or independently completes special projects such as presentation materials."