Customer Service Representative I (Spanish Speaking)
Astrana Health, El Monte, CA, United States
Location:
9700 Flair Drive, El Monte, CA 91731
Member/Provider/Health Plan/Vendor/Hospital/Broker:
Department:
Ops - Member Services
Location:
9700 Flair Drive, El Monte, CA 91731
Compensation:
$18.90 - $24.25 / 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 Spanish.
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 4th quarter
Outreach project from internals – QCIT ...
#J-18808-Ljbffr
9700 Flair Drive, El Monte, CA 91731
Member/Provider/Health Plan/Vendor/Hospital/Broker:
Department:
Ops - Member Services
Location:
9700 Flair Drive, El Monte, CA 91731
Compensation:
$18.90 - $24.25 / 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 Spanish.
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 4th quarter
Outreach project from internals – QCIT ...
#J-18808-Ljbffr