Bilingual Member Service Rep II

AFMC; Fort Smith (AR); Hybrid; USD 35,000 - 45,000; Full time

Job summary

AFMC is seeking a full-time customer service representative focused on the Arkansas Medicaid program. The role entails providing information and resolving grievances for Medicaid members, with responsibilities including coordination with various healthcare components.

Candidate must be bilingual (English/Spanish) and knowledgeable about Medicaid guidelines. The position offers the flexibility to work from home with high-speed internet requirements.

Qualifications

• Bilingual in English and Spanish.
• Two years of experience in customer relations or a call center setting.
• Understanding of Medicaid guidelines.

Responsibilities

• Coordinate communication between various components of the AR Medicaid program.
• Responsible for resolving customer/client requests and documentation.
• Assist in the creation and maintenance of necessary reports and documents.

Skills

Intermediate computer skills (Excel, Word, Power Point, Outlook)

Exceptional skills in business English and spelling

Strong oral and written communication skills

Ability to multitask

Strong organizational skills

Education

High School Diploma

Tools

MMIS

CURAM

JIRA ticket system

ANSWER

Job description

Job Title

Full-Time

Location

Work from Home FSM Based - Fort Smith, AR 72903 US
Work from Home LR Based - Little Rock, AR 72201 US (Primary)

Education

High School

Job Description

SCOPE OF POSITION: Maintain knowledge of the Arkansas Medicaid program, provide effective and efficient customer service to Medicaid Members for Arkansas Medicaid Program or Premium assistance programs. Maintain knowledge to respond to and resolve grievances and complaints; provide accurate and up to date information, and to assist in resolving issues or concerns about healthcare coverage; ability to familiarize Members with enrollment in a qualified health plan by using the ACCESS Arkansas portal; assign or change PCPs at request of Members; ability to assist Members who seek dental care coordination services by providing dental benefit information, finding a dentist or dental specialist, scheduling dental appointment, arranging transportation for the appointments; ability to assist eligible Medicaid Members in changing their assignment in managed care dental plans. Service as subject matter expert on assigned contract deliverables. Document services rendered in the appropriate format and in the appropriate system as designated by AFMC and provide reporting as required. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence, Accountability, Respect and Teamwork.

ESSENTIAL JOB FUNCTIONS

• Coordinate communication between various components of the AR Medicaid program.
• Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment. Knowledge should include information regarding: contract, contract deliverables, policies and procedures, resources available, current research and reports, trends, etc.
• Responsible for the resolution of customer/client requests including research, referral, policy review, revision and development, documentation and follow up in accordance with established policy/procedures.
• Communicate effectively with customers and/or recipients. Develop and maintain working relationships as necessary to meet contract deliverables of specialty area project.
• Act as a resource to internal and external customers for information pertaining to specialty area focus.
• Work with Information Services department to coordinate system developments and customizations.
• Assist in the creation and maintenance of necessary reports/documents to track and report project information. Prepare ad hoc reports and/or statistics as directed.
• Monitor specific items within the area of focus, provide recommendations/feedback to external customers for quality improvement and follow through for compliance of recommendations for improvement.
• Training and knowledge in all other areas of Members Services to assist as needed with the overall operation of the Member Services department.
• Assist PASSE Members in changing their initial auto-assignment to a PASSE entity, complete the change in the MMIS system and document all PASSE correspondence using the JIRA ticketing system.
• Maintain knowledge to efficiently function using Contractor’s software: MMIS, CURAM, JIRA ticket system, and ANSWER.
• Daily quotas may be added to meet contract deliverables as needed.
• Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
• Communicate needs and requests to other team members as appropriate.
• Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
• Adhere to AFMC Quality Standards of Excellence.
• Additional duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

• Must possess intermediate level computer skills (Excel, Word, Power Point and Outlook)
• Type 25 wpm
• Exceptional skills in business English and spelling
• Ability to maintain confidentiality
• Strong oral and written communication skills
• Creativity
• Ability to meet deadlines
• Flexibility
• Ability to work collaboratively and independently to achieve stated goals
• Initiative
• Ability to relate professionally and positively with staff, business partners, customers, constituents, members and the public
• Ability to multitask
• Ability to prioritize
• Strong organizational skills
• Professionalism
• Ability to read, interpret and apply laws, rules and regulations
• Knowledge of quality improvement processes and techniques
• Ability to work overtime as needed

Job Requirements

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices): Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.

EDUCATION

Required: High School Diploma

EXPERIENCE

Required : Bilingual English/Spanish. Two (2) years’ experience within the healthcare arena, an understanding of Medicaid guidelines, customer relations, and call center experience.
Desirable : Experience within the healthcare arena and understanding of the Medicaid Guidelines

INTERNET REQUIREMENTS

Reliable, high-speed wireless internet service (Wi-Fi)
An upload speed of at least 5Mbps is required to support softphone functionality.

Equal Opportunity Employer/Veterans/Disabled EEO IS THE LAW

AFMC, Inc. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability or any other status protected by federal, state and/or local law. AFMC invites any employee and/or applicant to review the Company’s Affiant Plan. This plan is available for inspection upon request, which may be made in person or by telephone [phone], by fax [phone] or by U.S. mail Attn: Human Resources, 1020 West 4th Street, Suite 400, Little Rock, AR 72201.