Description
Astrana is looking for a Member Service Representative to join our fast and growing Dynamic team.
Our Values :
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitalsCollect Elicit information from members / providers including the problem or concerns and provide general status informationVerify authorization, claims, eligibility, and status onlyAll calls carefully documented into Company’s customer service module & NMM Queue systemMember / Provider Service / Representative assists Supervisor and Manager with other duties as assignedMember outreach communications via mail or telephoneAssist Member appointment with providersResolve walk-in member concernsAble to provide quality service to the customersAble to communicate effectively with customers in a professional and respectful mannerMaintain strictest confidentiality at all timesSpecialist termination notifications sent to membersUrgent Medicare Authorization Approval – Notification to Medicare membersTransportation arrangement for Medicare & Medi-Cal membersOutreach Project AssignmentsINBOUND CALLS :
Member / Provider / Health Plan / Vendor / Hospital / Broker :
All calls carefully documented into Company’s customer service moduleAnnual Wellness Visit (AWV) – Gift card pick up and schedulesAppointment of Representative (AOR) for Medicare MembersAttorney / Third Party Vendor callsAuthorization status / Modification / Redirection / CPT Code changes / Quantity adds / Explain Denied Auth / Peer to Peer calls / Extend expired auth / Pre-certified auth status / Retro / 2ndor 3rd opinion /Conduct 3 way conference call to Health Plan with memberConference call with Providers – Appointments, DME,COVID – 19 related questions (Tests & Vaccines)Direct Member Reimbursement (DMR)Eligibility – Demographic changes : Address / Phone / Fax Changes / Name changeEscalated calls from providers / membersHealth Diary PassportHealth Source MSO – Assist & arrange inquiries on Eligibility / Change PCP / Benefit with AHMCHIPPA Consent – Obtain Member Consent verificationInquiries on provider network / provider rostersLab locationsMember & Provider Complaints / GrievancesMember billsMiscellaneous callsPharmacy – Drug / medication pick up and coverageProvide authorization status for Hospital / CM DeptSelf-Referral Request for MedicareReturn MailTrack Mail Packages / Certified mail statusTranslations – Spanish / ChineseUrgent Care / locations / operations hoursOUTBOUND CALLS :
Member / Provider / Health Plan / Vendor / Hospital / Broker :
Assist Case Management on CCS – age in 21 years for change of PCP from Pediatrics to FP / IMAssist Marketing on email inquiriesAssist PR / Elig – Members assigned to wrong PCP / with no PCP statusAssisted UM / Medical Directors on urgent member appointment from escalated casesAuthorization status response call backBenefits – return call once information is obtained / verifiedComplaints / Grievances – return calls once resolution is obtainedDME – Translation support in Spanish and Chinese to confirm item / appointment set up for DME departmentEligibility – return call to providers / labs when member is added to system while waiting at the office.Member bills – return calls once resolution is obtainedMember Survey – Annually : every 4thquarterOutreach project from internals – QCITResolve walk in members concernsSpecialist Termination notification sent to membersTransportation arrangement for Medicare / Medi-Cal membersVoice mail – return calls back to callersCONCIERGE SERVICES – ESSENTIALS DUTIES AND REQUIREMENTS :
Assist to contact new members / IPA member transfer on new PCP assignment as neededWork group discussions on work status / progress on new member / IPA transferUpdate call log and provide daily / weekly status as neededFacilitate members with complex pre-existing conditions, medications, PCP / SPC network reviewsConference call with PCP selection / changeHelp member to identify member bill status, connect provider with on billing and claim submissionResponsible for experience of the membership associated with new member / IPA transferResponsible for to interact with Health Plan’s Customer Service Team to serve new member / IPA transferProblem Solving complex cases / brain storm with MS management team for resolutionQualifications :
High School Diploma or GEDExperience using Microsoft applications such as Word, Excel and OutlookExperience working in customer serviceOne year related experience and / or training; or equivalent combination of education and experience.You're a great for this role if :
You have previous work experience working in a healthcare settingYou are fluent in both Mandarin and Cantonese.Environmental Job Requirements and Working Conditions
This position is remotely based in the U.S.The total compensation target pay range for this role is : $20.00 per hour. This salary range represents our national target range for this role.Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information :
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 10,000 physicians to provide care for over 1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Salary : $20
