Organizational Description

The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health. In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

Position Title: Customer Care Associate I

Department: Customer Care

Reports To: Customer Care Supervisor

Classification: Non- Exempt

Status: Full Time (Regular)

POSITION SUMMARY

With supervision, develop and maintain a broad, integrated understanding of programs, policies, and procedures within CHCN. Answer and respond to CHCN-MSO related customer issues that are received by way of telephone to meet customer expectations and departmental goals and objectives.

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.

• Respond and resolve all first level, inbound inquiries and issues regarding member eligibility, claims, authorizations, and provider services.

• Consistently utilize multiple resources to resolve inquiries while on the phone.
• Follow through on customer issues promptly and accurately until completion.
• Transfer complex issues to appropriate staff after completely and accurately acquiring information regarding issue.

• Accurately update and document EZCAP Customer Service records with all information pertaining to more complex inquiries.

• Communicate with the members, physicians, internal departments and other internal and external customers in a professional, courteous, and respectful manner to reflect CHCN’s goal of excellent customer service.

• Suggest efficiencies that will benefit the department.

• Promote the usage of CHCN Connect Portal and provider procedural support for existing users.

• Auditing Daily Open Incident reports: closing CSI that are open and calling providers back if necessary.

• Assist members that come into the office with questions about membership.

• Grievance and Appeals Process the Health Plans
  • Completing denial packets
  • Forwarding requested medical records to HMO by due date requested
  • Forwarding Quality Improvement (complaints) to clinics and forwarding their responses back to the HP by due date requested
  • Tracking grievance and appeals on CSI and Excel

• Complete Daily Assignments:
  • Voice Mail processing
  • TPL requests from the Health Plan
  • TPL requests from Law Firms
  • Member Bills
  • Reply to emails
    • Customer Care inbox
    • Customer Care Fax inbox
    • Portal Support Emails
    • Remote Access Requests

HIPAA Designated Access

“For the purposes of the job duties of this position, the person in this position requires access only to the following HIPAA protected information data sets”

SUPERVISORY RESPONSIBILITIES

None

MINIMUM QUALIFICATIONS

Required Skills and Experience

• 1–3 years’ experience of commonly used customer service concepts, practices and procedures
• Ability to create a “satisfied customer experience” through energetic, passionate attention to the customer experience
• Ability to guide and manage a customer call.
• Ability to summarize customer issues and identify paths to solutions.
• Ability to answer 100-120 inbound calls per day from members, providers’ offices, health plans and other external customers
• Ability to learn and implement new ideas, processes, procedures quickly
• Ability to work collaboratively within a team
• Ability to communicate effectively both orally and in writing.

Desired Experience

• Bi-lingual in Spanish, Cantonese, or Vietnamese a plus
• Healthcare background working with MSOs, or medical billing a plus

Required Education

High school diploma required, 2 year college degree preferred.

General CHCN Roles

• Fosters an environment that promotes trust and cooperation among clients and staff.
• Enforces policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented.
• Accountable for participating in decision making processes and understanding the outcome(s).
• Understands the values and principles of CHCN and applies them in work responsibilities.
• Participates in outreach activities, agency advocacy, and serves on ad hoc committees, as requested.

CERTIFICATES AND/OR LICENSES

None

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to an inside environment.