Coord I, Customer Service

The Customer Service Coordinator I is responsible for advocating for members, providers, and health plans affiliated with the organization. This role will provide exceptional customer service at all times by assisting with referral inquiries, resolving member concerns, responding to general inquiries, educating members on health group programs and services, and ensuring member satisfaction with each interaction.

• Professional Duties

  - Receive and respond to inquiries via phone, email, text, and other channels in a professional and timely manner, using various types of software in a professional and timely manner.
• - Provide accurate and relevant information to members regarding referrals/referral status, referral process, health plan programs and services, and other general information inquiries.
• - Perform timely referral-related research using available resources to resolve member, provider, and health plan inquiries in accordance with established policies and procedures.
• - Document member interactions and encounters in the appropriate software systems with completeness and accuracy.
• - Resolve member complaints escalate to member health plan when appropriate.
• - Educate members on referral, appeal and grievance processes, PCP assignment, health plan selection, and enrollment in special programs and services; ensuring proper guidance and assistance throughout these processes.
• - Conduct outreach to members via phone and text to communicate urgent referral decision details, correct address issues from returned mail, and respond to member inquiries for assistance and information.
• - Collaborate with team members, internal departments, and staff across the organization to address complex member issues.
• - Participate in training and educational programs offered internally to remain abreast of updates in policies, procedures, workflows and industry regulations to ensure job performance meets expected standards.
• - Perform other duties as assigned.
• - Educates members on the variety of specialty programs DOHC offers. Alerts the appropriate specialty area if a need is identified.
• - Prepares daily authorization letters for mailing to members in a timely manner.
• - Provide members with verbal notification of urgent referral determinations (approved, denied, deferred, redirected) in accordance with the Turn Around Time (TAT) requirements. Documents verbal notification in appropriate systems.
• - Perform other duties as assigned.
• - Serve as an ambassador for Desert Oasis Healthcare and Family Hospice Care at all times and positively shape the customer experience
• - Introduce self and your role
• - Be knowledgeable about your job so that you can serve others effectively
• - Help others, offering to assist (Ask, how may I help you?)
• - Do your share. Do what you say you will do and take action, follow through. Be willing to pitch in and help
• - Let your patients, customers and co-workers know what they can expect from you and follow through
• - Be an active listener (make eye contact, validate)
• - Assume a neutral position and suspend judgment of others
• - Address customers as Mr., Mrs., or Ms. until invited to do otherwise. Never use terms of endearment such as hon, dear, sweetie, etc.
• - Be accountable for your work
• - Be sensitive to factors that influence customers and co-worker’s situation including age, gender, culture, race and socioeconomic status. Be observant of others’ social cues (emotions) and respond appropriately
• - Speak clearly and use understandable language (avoid medical jargon or slang)
• - Summarize key information and provide written materials whenever possible
• - Validate to ensure understanding
• - Use open-ended questions to engage
• - Demonstrate appropriate body language and tone of voice
• - Answer all phone calls with a salutation, introduction and offer to assist (Good afternoon, Desert Oasis Healthcare or Family Hospice Care, this is (your name), how may I help you?)
• - Speak positively about your work, co-workers and Desert Oasis Healthcare and Family Hospice Care
• - See the positive in situations and in others
• - Avoid gossip and negativity
• - Offer to answer any additional questions that the person, patient or customer may have
• - Anticipate needs that will arise before your next meeting
• - Inform patients and co-workers of how and when to contact you under normal circumstances (phone number, email, a help line, Immediate Care, etc.) or when unforeseen issues arise

• Qualifications

  - High school diploma or equivalent required.
• - 1 year in a customer service role in a medical group setting required.
• - Knowledge of medical terminology, general knowledge of Managed Care industry, and ability to understand and explain healthcare concepts to others required.
• - Proficient in computer applications and ability to learn and navigate new software and technologies.
• - Strong oral and written communication skills, including proper grammar and spelling.
• - Strong problem solving and critical thinking skills with attention to detail.
• - Ability to perform effectively in a fast-paced, high pressure, and dynamic environment.
• - Proven ability to work independently, manage multiple priorities, and prioritize effectively.
• - Bilingual (Spanish) preferred.
• - At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.

• Physical Demands

  type

  Sitting

  - Approximately 90% of day.
• type

  Standing

  - Approximately 5% of day.
• type

  Walking

  - Approximately 5% of day.
• type

  Lifting

  - 0 - 10 lbs. (equipment, supplies) approximately >5% of day.
• type

  Bending

  - Approximately 5% of day. Kneeling <5%.
• type

  Hearing/Visual Acuity

  - Adequate for use with computers and telephone. Approximately 100% of day.
• type

  Computer

  - Highly technical work environment. Must be able to work at least 7 hours a day using keyboard, mouse and monitor.
• type

  Reaching

  - Above head 75 degrees approximately 5% of day.
• type

  Hand grip dexterity

  - Approximately 90% of day.