Clinical Reporting, Associate, BH Outreach Specialist
Status: Full-time, Exempt: No
This position will contact targeted members from the Medicaid line of business who are eligible for MVP’s Rewarding Quality Incentive program. In addition, they will make calls to members from all lines of business, as needed, for focused outreach programs. As the personal point of contact for these programs, the responsibility for efficient, customer service-oriented telephone interface
is paramount. The individual will:
• Lead efforts to locate and engage new and previously hard-to-engage members. This individual works to overcome language and cultural barriers and engages caregivers and/or household members, as applicable.
• Use internal and external resources (such as claims, referrals, and pharmacy data) to identify accurate, successful modes of communication with unreachable or hard-to-reach members.
• Conduct brief assessments with the members identified to introduce the program and discuss their concerns and barriers for future follow up on all preventative care needs.
• Utilize communication skills to gain trust from members to participate in the programs; persistently forges trusting relationships and engages individuals not readily interested in such activities. Prompts the importance of preventative care.
• Provide optimum customer service as required to all members. Takes full responsibility for every call to ensure callers concerns are met in a timely manner and the program is designed to assist in any concern the member may want to express.
• Simultaneously access multiple databases while addressing customer’s needs. Works in several applications to ensure members reach their goals to achieve program incentives
• Research information needed to accurately respond to customer concerns. Ask appropriate questions to ensure a clear understanding of customer concerns.
• Utilizes established workflows and collaborates with internal and external stakeholders such as: Member Services, Care Managers, Enrollment, Population Health Managers, Value
Based Care Partners.
• Respond promptly, accurately and effectively to all calls in a polite and professional manner. Calls are returned to the member and/or provider based on information needed at the time of the call.
• Perform data input in a highly accurate and timely manner on all customer contacts. Calls or claim reviews are documented in Care Radius with all pertinent information for reports to be obtained to assist the department in meeting goals.
• Acts like a liaison between MVP’s internal and external customers regarding membership, eligibility, retention and education about their plan.
• Utilize knowledge of the New York State Department of Health and website for guidance on eligibility concerns and/or questions regarding member updates such as demographics, etc. • Use technical skills required to be able to perform tasks efficiently.
• Obtain a comprehensive understanding of all lines of business.
The qualified candidate will have the skills needed to engage with the population, appropriately document throughout assessment process, and schedule additional outreach per process or as assigned. All information regarding the contacts is entered into the care management system. The Member Outreach Specialist strictly maintains the confidentiality of our member and provider information. Performs other duties as assigned.
High School diploma or equivalent education. Licensed Social Worker preferred.
At least 2 years Behavioral health experience
At least 2 years relevant health insurance, medical or healthcare call center or claims experience with at least one-year managed care experience preferred.
• Excellent client service/telephone skills and ability to deal with stressful phone calls in a calm and diplomatic manner;
• Excellent computer skills including working knowledge of Microsoft Office, Word and Excel and the internet
• Familiarity with medical terminology
• Strong written and verbal communication skills
• Experience in positions requiring strict adherence to confidentiality
MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at firstname.lastname@example.org.
- Job Family Medical Management/Clinical
- Pay Type Hourly
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