Customer Service Representative I (Spanish Speaking)
ApolloMed, El Monte, California, United States, 91731
Customer Service Representative I (Spanish Speaking)
Astrana is looking for a Customer Service Representative to join our fast and growing dynamic team. This position requires speaking fluent in Spanish. What You'll Do
Your responsibilities will include: Answering all daily telephone calls from members, providers, health plans, insurance brokers, collection agents, and hospitals. Collecting and eliciting information from members/providers including the problem or concerns and providing general status information. Verifying 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. Assisting Member appointment with providers. Resolving walk-in member concerns. Providing quality service to the customers. Communicating effectively with customers in a professional and respectful manner. Maintaining the strictest confidentiality at all times. Sending specialist termination notifications to members. Notifying Medicare members of urgent Medicare Authorization Approval. Arranging transportation 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: 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 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
Required qualifications include: 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. Fluency in Spanish. 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. 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. About Astrana Health, Inc.
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 20,000 physicians to provide care for over 1.7 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. Our Hiring Process
The hiring process includes:
Astrana is looking for a Customer Service Representative to join our fast and growing dynamic team. This position requires speaking fluent in Spanish. What You'll Do
Your responsibilities will include: Answering all daily telephone calls from members, providers, health plans, insurance brokers, collection agents, and hospitals. Collecting and eliciting information from members/providers including the problem or concerns and providing general status information. Verifying 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. Assisting Member appointment with providers. Resolving walk-in member concerns. Providing quality service to the customers. Communicating effectively with customers in a professional and respectful manner. Maintaining the strictest confidentiality at all times. Sending specialist termination notifications to members. Notifying Medicare members of urgent Medicare Authorization Approval. Arranging transportation 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: 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 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
Required qualifications include: 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. Fluency in Spanish. 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. 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. About Astrana Health, Inc.
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 20,000 physicians to provide care for over 1.7 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. Our Hiring Process
The hiring process includes: