Customer Service Representative (Cantonese or Mandarin Speaking)
Job Title: Customer Services Representative
Department: Operations - Member Services
About the Role: Astrana is looking for a Customer Service Representative to join our fast and growing Dynamic team. This position requires speaking fluent in Cantonese or Mandarin to assist with our member population.
What You'll Do
- Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals
- Collect Elicit information from members/providers including the problem or concerns and provide general status information
- Verify authorization, claims, eligibility, and status only
- All calls carefully documented into Company’s customer service module & NMM Queue system
- Member/Provider Service/Representative assists Supervisor and Manager with other duties as assigned
- Member outreach communications via mail or telephone
- Assist Member appointment with providers
- Resolve walk-in member concerns
- Able to provide quality service to the customers
- Able to communicate effectively with customers in a professional and respectful manner
- Maintain strictest confidentiality at all times
- Specialist termination notifications sent to members
- Urgent Medicare Authorization Approval – Notification to Medicare members
- Transportation arrangement for Medicare & Medi-Cal members
- Outreach Project Assignments
INBOUND CALLS:
- Member/Provider/Health Plan/Vendor/Hospital/Broker:
- All calls carefully documented into Company’s customer service module
- Annual Wellness Visit (AWV) – Gift card pick up and schedules
- Appointment of Representative (AOR) for Medicare Members
- Attorney / Third Party Vendor calls
- Authorization 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 member
- Conference call with Providers – Appointments, DME,
- COVID – 19 related questions (Tests & Vaccines)
- Direct Member Reimbursement (DMR)
- Eligibility – Demographic changes: Address/Phone/Fax Changes/Name change
- Escalated calls from providers/members
- Health Diary Passport
- Health Source MSO – Assist & arrange inquiries on Eligibility/Change PCP/Benefit with AHMC
- HIPPA Consent – Obtain Member Consent verification
- Inquiries on provider network/provider rosters
- Lab locations
- Member & Provider Complaints/Grievances
- Member bills
- Miscellaneous calls
- Pharmacy – Drug/medication pick up and coverage
- Provide authorization status for Hospital /CM Dept
- Self-Referral Request for Medicare
- Return Mail
- Track Mail Packages/ Certified mail status
- Translations – Spanish / Chinese
- Urgent Care / locations/ operations hours
OUTBOUND 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/IM
- Assist Marketing on email inquiries
- Assist PR/ Elig – Members assigned to wrong PCP/with no PCP status
- Assisted UM / Medical Directors on urgent member appointment from escalated cases
- Authorization status response call back
- Benefits – return call once information is obtained / verified
- Complaints/Grievances – return calls once resolution is obtained
- DME – Translation support in Spanish and Chinese to confirm item / appointment set up for DME department
- Eligibility – return call to providers/labs when member is added to system while waiting at the office.
- Member bills – return calls once resolution is obtained
- Member Survey – Annually: every 4thquarter
- Outreach project from internals – QCIT
- Resolve walk in members concerns
- Specialist Termination notification sent to members
- Transportation arrangement for Medicare / Medi-Cal members
- Voice mail – return calls back to callers
CONCIERGE SERVICES – ESSEN