Astrana Health, Inc.
Customer Service Representative (Cantonese or Mandarin Speaking)
7 days ago
El Monte
Job DescriptionDescriptionJob 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. What You'll Do • Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals, • Collect Elicit information from members/providers including the problem or concerns and provide general status information, • Verify authorization, claims, eligibility, and status only, • All calls carefully documented into 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 appointment with providers, • Resolve walk-in member concerns, • Able to provide quality service to the customers, • Able to communicate effectively with customers in a professional and respectful manner, • Maintain strictest 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 INBOUND CALLS:, • Member/Provider/Health Plan/Vendor/Hospital/Broker:, • All calls carefully documented into 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/2ndor 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 OUTBOUND CALLS: Member/Provider/Health Plan/Vendor/Hospital/Broker:, • 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 4thquarter, • Outreach project from internals – QCIT, • Resolve walk in members concerns, • Specialist Termination notification sent to members, • Transportation arrangement for Medicare / Medi-Cal members, • Voice mail – return calls back to callers CONCIERGE SERVICES – ESSENTIALS DUTIES AND REQUIREMENTS:, • 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 to identify member bill status, connect provider with on billing and claim submission, • Responsible for experience of the membership associated with new member/IPA transfer, • Responsible for to interact with Health Plan’s Customer Service Team to serve new member/IPA transfer, • High School Diploma or GED, • Experience using Microsoft applications such as Word, Excel and Outlook, • Experience working in customer service, • One year related experience and/or training; or equivalent combination of education and experience, • You are fluent in Mandarin or CantoneseYou're a great for this role if:, • This is a remote role. The home office is aligned with your department at 9700 Flair Drive, El Monte, CA 91731, • This position will typically work Monday - Friday from 8:30am to 5:00pm PST., • The target pay range for this role is $20.00. This salary range represents national target range for this role.