Job Details

SCOPE OF POSITION: 
Must lead and direct daily work of member service representatives. Talk with Outreach staff and people on Medicaid to be sure services are timely and professional. Provide appropriate follow-up. Serve as an expert on assigned project or contract. Provide side-by-side staff coaching and training. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence Accountability, Respect and Teamwork.

ESSENTIAL JOB FUNCTIONS:

1. Ensure the quality and accuracy of employees’ work. Check that staff meets goals on time.
2. Stay informed about specialty area and health care environment. Must know terms and scope of contract, policies and procedures, resources, current research and reports, trends, etc.  
3. Help staff resolve problems. Serve as their resource and guide; keep working relationships positive.
4. Resolve requests with research, referral, policy review, revision and development, documentation and follow-up. Always comply with policy and procedures.
5. Understand and use project-tracking software to document and monitor services and activities. Create a complete database of activity. Maintain accurate data for contract and reporting.
6. Coordinate collection and data entry of required documentation.
7. Daily quotas may be added to meet contract requirements.
8. Follow format, content and style guides, ensure accuracy, consistency and quality.
9. Tell other team members about needs and requests.
10. Follow AFMC, state and federal rules about data privacy, security and HIPAA compliance.
11. Additional duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Must possess intermediate level computer skills (Excel, Word, Power Point and Outlook)
• Type 50 wpm
• Leadership skills
• Exceptional skills in business English and spelling
• Ability to maintain confidentiality
• Strong oral and written communication skills
• Creativity
• Customer service
• Ability to meet deadlines
• Attention to detail
• Flexibility
• Ability to work collaboratively and independently to achieve stated goals
• Initiative
• Ability to relate professionally and positively with staff, business partners, customers, constituents, beneficiaries and the public
• Ability to multitask
• Ability to prioritize
• Strong organizational skills
• Problem-solving skills
• Professionalism
• Project management skills
• Ability to work overtime, as needed
• Ability to read, interpret and apply laws, rules and regulations
• Ability to travel including overnight travel
• Time management skills
   

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
Desirable: Associate’s degree
    
EXPERIENCE:
Required: Three (3) years in the focus area of the position, which includes customer service and call center experience.
Desirable: Previous supervisory experience. Experience within the healthcare arena, 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.