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 – ESSENTIALS DUTIES AND REQUIREMENTS:
Assist to contact new members/IPA member transfer on new PCP assignment as needed
Work group discussions on work status/progress on new member/IPA transfer
Update call log and provide daily/weekly status as needed
Facilitate members with complex pre-existing conditions, medications, PCP/SPC network reviews
Conference call with PCP selection / change
Help member to identify member bill status, connect provider with on billing and claim submission
Responsible for experience of the membership associated with new member/IPA transfer
Responsible for to interact with Health Plan’s Customer Service Team to serve new member/IPA transfer
Problem Solving complex cases/ brain storm with MS management team for resolution
Other duties as assigned
Qualifications
High School Diploma or GED
Experience using Microsoft applications such as Word, Excel and Outlook
Experience working in customer service
One year related experience and/or training; or equivalent combination of education and experience
You are fluent in Cantonese or Mandarin
You're a great for this role if:
Environmental Job Requirements and Working Conditions
This is a remote role. The home office is aligned with your department at 9700 Flair Drive, El Monte, CA 91731
This position is required to work between Monday - Friday at 8:30am to 5:00pm PST.
The target pay range for this role is $17.50 - $22.00 per hour. This salary range represents national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
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 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 is a healthcare company that manages over a million lives across the country and operates in the managed care and healthcare operations space. The company generates and processes terabytes of healthcare data to drive innovation and improve patient outcomes. Astrana Health empowers provider and care teams through data-driven insights and robust data solutions. The company is focused on putting patients first while maintaining operational integrity and excellence across its data and analytics infrastructure.
