Healthcare Coordinator

  • location: Tampa, FL
  • type: Contract
  • salary: $20.08 per hour
easy apply

job description

Healthcare Coordinator

job summary:
Description:

Why work for Randstad? We have been consistently recognized as one of the "Best Places to Work" - and with good reason. We're a company of experts with a clear dedication to those we serve. We take the time to build relationships with clients and candidates so we can truly understand what they need - and how we can help them succeed. Our people drive our business.

ESSENTIAL FUNCTIONS

    Responds to member and provider inquiries regarding medicaid/medicare via phone and email Inquiries will include medicaid/medicare, claims, billing, and enrollment Demonstrates outstanding Customer Service Skills Document, Organize, and review case files reports on activity and customer follow up efforts
MINIMUM QUALIFICATIONS

  • A High School or GED Required
  • An Associate's Degree in a related field Preferred
Work Experience

  • 1+ year of experience in Contact Center and/or Customer Service Environment Required
  • 1+ year of experience in Experience within a Healthcare company Preferred
Skills

  • Demonstrated written communication skills
  • Demonstrated interpersonal/verbal communication skills
  • Ability to multi-task
  • Proficiency in Microsoft Office Suite
  • SharePoint Intermediate Preferred
  • Xcelys Intermediate Preferred
  • Other HPMS, MARx Intermediate Preferred
  • Spanish Preferred
Additional Skills:

Skills/Experience Required:

Call center exp. - required, Health Care and/or Medicare preferred

Qualification call notes from 7/2: Qual Call Notes:

- Position geared at answering complaints that go outside the company for Medicare

- Requires good documentation as we respond to CMS - Prefer Medicare background or health plan background o This helps training go faster/better

- This role helps escalate issues with members on needs not being met

- Schedule: o M-F (8-5) - Time Period: o July - October

- We hope to convert staff from this role if they are doing well - Require call center experience as the person will move on multiple desktops and phone and receive inbound calls (5-7 calls per day, from members and advocacy groups)

- Interview process: o Prefer in-person and it would be a panel (3 person)

- Can contact HM but please contact CWP first EditRemove

 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: High School
experience: 1 Years
 
responsibilities:
Description:

JOB SUMMARY

Responds to member, provider, CMS, SPAP and SHIP inquiries received via phone, CTM (Complaint Tracking Module) and email regarding PDP, CCP and Medicaid lines of business, including Claims, CIU, Enrollment, Pharmacy, Billing, Case Management, and Appeals in a professional, timely, accurate and caring manner- while consistently meeting all CMS guidelines and requirements. Instrumental in providing suggestions to reduce complaints and increase Company's Star Ratings.

ESSENTIAL FUNCTIONS

Note: The following is not intended to be an exhaustive list of all duties required of this position

Key Duties and Responsibilities

  • Responds to member, provider, CMS, SPAP and SHIP inquiries via telephone, CTM (Complaint Tracking Module) and email, while meeting all corporate, regulatory and CMS guidelines and performance standards. Independently evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare & Medicaid Services ("CMS") guidelines, and internal policies, procedures, and standards that are alleged to have been violated.
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified. Assist in the education of new members and in the re-education of existing members regarding health plan procedures.
  • Records, investigates and resolves complaints as detailed in the CMS Standard Operating Procedures (SOP) and the CTM Policies and Procedures.
  • Investigates problems of an unusual nature in the area of responsibility. Presents proposed solutions in a clear and concise manner.
  • Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks.
  • Thoroughly documents, organizes, and reviews case files electronically, relative to each investigation in accordance with Company policy and ensures remediation activities are implemented. Interact with other departments including Enrollment, Pharmacy, Billing, etc. to resolve member and provider issues.
  • Logs, tracks and follow-ups on all inquiries, utilizing on-line systems and procedures, according to the established guidelines.
  • Demonstrates expertise of all Company Medicare PDP, and CCP lines of business.
  • Drives and supports Company initiatives at the team level by interacting with peers and other internal and external business partners, such as RCA inquiries, Governance weekly meetings, Quality Audit calibrations, CMS Call Audits, and CSQIW/QIC while demonstrating a willingness to conform to Company policies and procedures.
  • Develops and presents ideas for performance and process management improvement within the department.
  • Supports the development and maintenance of Corporate Compliance policies and procedures and workflows.
  • Conducts and documents with beneficiaries, providers, interdepartmental investigatory purposes.
  • Acts as a primary contact for escalated calls and/or escalated issues in which special care is required to enhance Company relationships with members, providers, CMS Caseworkers, SPAPs and SHIPs.
  • Works on Good Cause Reinstatement cases and making sure members make full payment and are reinstated by our Enrollment Department within Medicare Guidelines.
  • Performs skills necessary to create a high-quality customer experience, as reflected through acceptable Quality scores.
  • Handles calls that require additional research and/or special handling- including regulatory, congressional, Swift, Press Hill, marketing, sales, executive office, Centers for Medicaid and Medicare Services (CMS), etc. Responsible for the intake and assignment of CTM complaints through HPMS/Inbound phone intake.
 
qualifications:
Additional Position Responsibilities - Optional

MINIMUM QUALIFICATIONS

Education

State the minimum required for the job

Education Level Education Details Required/Preferred


  • A High School or GED Required
  • An Associate's Degree in a related field Preferred
  • A Bachelor's Degree in a related field Preferred
Work Experience

State the minimum required for the job

Experience Level Experience Details Required/Preferred


  • 1+ year of experience in Contact Center and/or Customer Service Environment Required
  • 1+ year of experience in Experience within a Healthcare company Preferred
  • 1+ year of experience in CTM or Escalations Experience Preferred
Licenses and Certifications

  • List professional licenses and certifications associated with this job
  • Licenses/Certifications Other Licenses/Certifications Required/Preferred
  • Other Customer service, quality or training certifications Preferred
Skills

State the minimum required for the job

Skill Sets Other Skills Proficiency


  • Demonstrated written communication skills Advanced
  • Demonstrated interpersonal/verbal communication skills Advanced
  • Ability to multi-task Intermediate
  • Demonstrated organizational skills Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Ability to effectively present information and respond to questions from families, members, and providers Intermediate
  • Demonstrated analytical skills Intermediate
  • Other Ability to work with people from diverse backgrounds Intermediate
  • Other Ability to act on feedback provided by showing ownership of his or her own development Intermediate
  • Other Ability to define problems collects data, establish facts and draw valid conclusions Intermediate
  • Other Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication Intermediate
Technology

List technical skills associated with the job

  • Technology Other Technology Proficiency Required/Preferred
  • Microsoft Outlook Intermediate Required
  • Microsoft Word Intermediate Required
  • Microsoft Excel Intermediate Required
  • Microsoft PowerPoint Intermediate Preferred
  • SharePoint Intermediate Preferred
  • Xcelys Intermediate Preferred
  • Other HPMS, MARx Intermediate Preferred
Languages

List all that apply

Languages Other Languages Required/Preferred


  • Spanish Preferred
Additional Skills:

Skills/Experience Required:

Call center exp. - required, Health Care and/or Medicare preferred

Qualification call notes from 7/2: Qual Call Notes:

- Position geared at answering complaints that go outside the company for Medicare

- Requires good documentation as we respond to CMS - Prefer Medicare background or health plan background o This helps training go faster/better

- This role helps escalate issues with members on needs not being met

- Schedule: o M-F (8-5) - Time Period: o July - October

- We hope to convert staff from this role if they are doing well - Require call center experience as the person will move on multiple desktops and phone and receive inbound calls (5-7 calls per day, from members and advocacy groups)

- Interview process: o Prefer in-person and it would be a panel (3 person)

- Can contact HM but please contact CWP first EditRemove

 
skills: Other
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

easy apply

get jobs in your inbox.

sign up
{{returnMsg}}

related jobs

    Healthcare Coordinator

  • location: Tampa, FL
  • job type: Contract
  • salary: $20.08 per hour
  • date posted: 8/28/2019