This job was posted by https://www.arjoblink.arkansas.gov : For more
information, please see: https://www.arjoblink.arkansas.gov/jobs/4170976
SCOPE OF POSITION:
Maintain knowledge of the Arkansas Medicaid program, provideeffective
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 organizations 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 Contractors
software: MMIS, CURAM, JIRA ticket system, and ANSWER.
- Daily quotas may be added to meet contract deliverables as needed.
13. Assist in interviewing for Spanish fluency.
- 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.
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 2Mbps is required to support softphone
functionality.
KNOWLEDGE, SKILLS, AND ABILITIES