The Member and Recipient Services Coordinator provide a broad range of customer service functions to individuals that contact the Tailored Plan (TP) Member and Recipient Services Call Center. This position provides general information regarding accessing services in the TP provider network, and on the various functions and processes of TP departments. This position assures consumers/guardians seeking routine services are referred to services or are transferred to licensed clinicians for clinical screening and triage.
This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required.
Responsibilities and Duties
Customer Service & Support
- Receive calls from members, recipients, and community stakeholders
- Provide education to callers regarding all areas of TP functions
- Availability and appropriateness of contracted providers;
- General information about managed care and NC Medicaid Tailored Plans;
- General information about state-funded services and NC Medicaid Direct;
- Benefit plans and member/recipient eligibility for services;
- Choosing and changing member PCPs;
- Choosing and changing AMH+ and care management entities;
- Role and expectation of care management entities;
- Grievance and complaint procedures;
- Navigating the Alliance Health website and member portal;
- Eligibility and scheduling transportation; Eligibility and referral for value added services
- Maintain calm, helpful, appropriate demeanor and decision-making for all callers, including angry, abusive, threatening, and harassing callers
Initial Coordination & Triage
- Escalate urgent and emergent calls to a licensed clinician
- Complete routine screening and referral a timely manner
Consumer Scheduling
- Assist callers with addressing obstacles to accessing care and identify available resources
- Engage in follow-up activities to ensure consumers were seen for scheduled assessments and schedule aftercare appointments
- Reschedule consumer missed appointments
Documentation & Reporting
- Record consumer demographics in electronic health record (EHR)
- Record grievances resolved and/or pending resolution
- Receive, answer and record provider inquiries in EHR
- Document all incoming call activity in EHR
- Report patterns of atypical call and service seeking patterns to supervisor
Adhering to Workflow
- Continue work efforts without interruption while managing technological disruptions and outages
- Operate and navigate a multi-function phone system with multiple software programs while managing caller needs
- Operate and navigate multiple software programs in course of all duties
- Read, integrate, and adapt procedural tasks in a rapidly changing, paperless work environment
- Work independently to prioritize tasks and maintain idle status in call queue during high call volume and/or low staffing periods
- Monitor incoming fax system and overflow vendor reports to ensure written referrals receive appropriate attention within expected time frames
- Train incoming staff to job duties and functions of the call center
- Interact with community services orally while receiving information orally and in writing via IM, when called upon to do so
- Engage interpreter services when needed and adjust communication accordingly
- Troubleshooting of hardware and multiple software programs, including security protocols, VPN, and software behind the firewall
Minimum Requirements
Bachelor’s degree from an accredited college or university in Human Services or related field and four (4) years’ experience in a community, business or governmental program that delivers mental health support services (e.g., adults with mental illness, children with severe emotional disturbance, persons with developmental disabilities, adults and children with substance abuse disorders)
Preferred: Master’s degree and clinical experience preferred.
Knowledge, Skills, and Abilities
- Knowledge of the six-county area and its human services agencies, community resources, churches, schools, and related organizations that provide services to clients and their families
- Knowledge of TP care management programs
- Knowledge of state and federal client rights protection statues, regulations, and applicable laws
- Effective written and oral communication skill, interpersonal skills, excellent customer service skills
- Ability to analyze oral and written information to identify rights protection complaint issues
- Ability to multitask, manage time, prioritize work, and use problem-solving approaches
- Ability to coordinate effectively with staff from various agencies
- Ability to read, analyze, and interpret regulations, policies, and procedures to service providers
- Ability to execute work plans and coordinate work effectively
- Ability to operate computer equipment and generate reports and records
- Proficient in using basic computer programs, internet
- Ability to learn specific data programs used for call center tracking
- Ability to triage caller needs for urgency and resolve issues in a calm and supportive manner
- Ability to perform in a fast paced, ever changing and often high stress environment
Salary Range
$25.75 - $32.83/Hourly
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity
An excellent fringe benefit package accompanies the salary, which includes:
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
