Participant Satisfaction Lead

Job Summary: 

With excellent customer service skills, this role communicates with participants to provide information and resolve issues, coordinating with other team members to provide complete and thorough responses to participants.

Strong interpersonal, written and verbal communication, administrative, and organizational skills, and the ability to maintain a realistic balance among multiple priorities are necessary for this position.

Reporting to the Quality Manager, the Participant Satisfaction Lead is responsible for monitoring the Interdisciplinary Teams’ responsiveness to PACE participants, tracking communication and service delivery, and bringing action items to the attention of the IDT and Management.

There are 3 key areas of responsibility for this role.

1. Communicate with participants regarding grievances, service requests, questions about appointments, providing excellent customer service and responsiveness. Places high priority on participants at risk of disenrollment.
2. Coordinate the activities of the IDT AAs and ensure they are performing assigned tasks in an accurate, timely, and thorough manner. 
3. Provide actionable team-specific data to the IDT and managers that shows where teams are exceeding, meeting, or lagging established benchmarks.

The Participant Satisfaction Lead coordinates the activities of the IDT-AAs, monitors their performance, and provides coverage as needed. This role must know the regulatory requirements and timeframes the IDT must meet and will support processes that support the IDT’s compliance. 

Job Duties/Responsibilities:

• Communicates directly with participants; informs participants of service determination decisions, provides updates on service delivery dates, follows up after complaints/grievances. Returns participant phone calls in timely manner. 
• Assists Quality Manager in the processing of multi-part grievances, contacts participants to ensure satisfaction with resolutions and that problems have been successfully addressed.
• Performs chart reviews on select participants who have filed grievances to gather additional information regarding the services that have been provided.
• Remains aware of participant satisfaction, identifies participants at risk of disenrollment. Alerts appropriate staff that interventions are needed; supports interventions as requested. 
• Serves as point of contact for participants who are having difficulty getting responses from staff at PACE.
• Supports the work of the care teams as Lead of the IDT Support Team by monitoring daily IDT-AA activity, assisting in problem solving, and serving as back up in case of absence.
• Creates and maintains system to track Teams’ performance related to Care Plans, SDRs, Assessments, Grievances, and Authorizations.
• Works with Medical Coder to provide oversight of ED and Hospital authorizations; works with Finance and Contracts to oversee ALF and NH authorizations.
• Collaborates with clinical managers, Quality, and Compliance to identify, track, and report on identified metrics.
• Models excellent customer service for IDT-AAs; responds to requests in a timely and thorough manner.
• Engages in problem solving with IDT-AAs and participants.
• With IDT-AAs, issues reminders to IDT members for upcoming deliverables.
• Monitors the preparation and tracking of all service delivery request documents (SDRs) across all Teams, assists in composing denial of service letters when appropriate.
• Serves as backup facilitator or scribe when needed for care planning meetings and morning team meetings. Attends all morning team meetings to ensure meetings are running smoothly and processes are being followed by all attendees. 
• Using quality improvement tools, collaborates with members of the IDT on necessary improvements identified through audits.
• Operates personal computer to compose and edit correspondence and/or memoranda from verbal direction, or from knowledge of established department/division policies; may prepare, transcribe, compose, type, edit, and distribute agendas and/or minutes of meetings as directed.
• Assists IDT AAs in updating the participants’ medical records as needed. 
• Support the IDT-AAs in the maintenance of the Care Plan calendar, scheduling of Care Plans, and scheduling of Huddles. Alerts Team managers and Compliance to out-of-compliance care plans. 
• Performs other related duties as required and assigned.

Required Skills & Abilities: 
Ability to maintain confidentiality
Ability to prioritize tasks
Proficiency with MS Office Suite or similar software
Proficiency with Excel; ability to produce graphs and data driven reports
Dependable and punctual with ability to maintain consistent attendance 
Ability to read, write and comprehend English 
Ability to maintain sound judgement under stress and communicate effectively 

Education Requirements:
High School Diploma or Equivalent, Required
Bachelors, Preferred 

Physical Requirements:
Must be able to tolerate prolonged periods sitting at a desk and working on a computer.
Must be able to lift up to 10 pounds and at times up to 20 pounds.
Must be able to navigate various departments of the organization's physical premises as well as related community care settings.
Must be able to tolerate conditions typically associated within a medical office and/or home care setting including potential exposure to bloodborne pathogens and infectious diseases. 

Experience:
2 to 5 years of Administrative Support Experience, Preferred
1 to 3 years of Medical Office/Clinical Experience, Preferred 
1 to 3 years of EMR Experience, Preferred 
1 year of experience working with a frail or elderly population, Preferred 

License & Certification Requirements:
None

Position Requirements:
Driver's License & access to reliable transportation: community-based travel required.