Customer Service Representative ; Cantonese or Mandarin Speaking

Overview

Location: 9700 Flair Drive, El Monte, CA 91731

Department: Ops - Member Services

Compensation: $20.00 / 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 Cantonese or Mandarin.

• Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals
• Collect and elicit information from members/providers including the problem or concerns and provide general status information
• Verify authorization, claims, eligibility, and status only
• Document all calls into the 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 appointments with providers
• Resolve walk-in member concerns
• Provide quality service to customers
• Communicate effectively with customers in a professional and respectful manner
• Maintain 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

• Member/Provider/Health Plan/Vendor/Hospital/Broker:
  All calls documented into the 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/2nd or 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

• 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 member concerns
• Specialist Termination notification sent to members
• Transportation arrangement for Medicare / Medi-Cal members
• Voice mail – return calls back to callers

• 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 identify member bill status, connect provider with billing and claim submission
• Responsible for…