Customer Service Representative I (Cantonese or Mandarin Speaking)
Astrana Health, El Monte, California, us, 91734
Overview
Location:
9700 Flair Drive, El Monte, CA 91731 Department:
Ops - Member Services Compensation:
$20.00 / hour Description : 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. What Youll Do
Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals Collect and elicit information from members/providers including the problem or concerns and provide general status information Verify authorization, claims, eligibility, and status only Document all calls into the 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 appointments with providers Resolve walk-in member concerns Provide quality service to customers Communicate effectively with customers in a professional and respectful manner Maintain 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 documented into the 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/2nd or 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
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 4th quarter Outreach project from internals – QCIT Resolve walk-in member concerns Specialist Termination notification sent to members Transportation arrangement for Medicare / Medi-Cal members Voice mail – return calls back to callers CONCIERGE SERVICES – ESSENTIAL 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 identify member bill status, connect provider with billing and claim submission Responsible for experience of the membership associated with new member/IPA transfer Interact with Health Plan’s Customer Service Team to serve new member/IPA transfer Problem solving for complex cases / brainstorm with MS management team for resolution Other duties as assigned Qualifications
High School Diploma or GED Experience using Microsoft 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 Mandarin or Cantonese You're a great fit for this role if
You have previous work experience working in a healthcare setting 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 will typically work Monday - Friday from 8:30am to 5:00pm PST. The target pay range for this role is $20.00. This salary range represents 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.
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Location:
9700 Flair Drive, El Monte, CA 91731 Department:
Ops - Member Services Compensation:
$20.00 / hour Description : 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. What Youll Do
Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals Collect and elicit information from members/providers including the problem or concerns and provide general status information Verify authorization, claims, eligibility, and status only Document all calls into the 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 appointments with providers Resolve walk-in member concerns Provide quality service to customers Communicate effectively with customers in a professional and respectful manner Maintain 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 documented into the 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/2nd or 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
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 4th quarter Outreach project from internals – QCIT Resolve walk-in member concerns Specialist Termination notification sent to members Transportation arrangement for Medicare / Medi-Cal members Voice mail – return calls back to callers CONCIERGE SERVICES – ESSENTIAL 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 identify member bill status, connect provider with billing and claim submission Responsible for experience of the membership associated with new member/IPA transfer Interact with Health Plan’s Customer Service Team to serve new member/IPA transfer Problem solving for complex cases / brainstorm with MS management team for resolution Other duties as assigned Qualifications
High School Diploma or GED Experience using Microsoft 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 Mandarin or Cantonese You're a great fit for this role if
You have previous work experience working in a healthcare setting 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 will typically work Monday - Friday from 8:30am to 5:00pm PST. The target pay range for this role is $20.00. This salary range represents 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.
#J-18808-Ljbffr