Contact Center Care Coordinator I

Come Grow With Us
At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges.

Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person - health, health care, and social services and supports - are met. We are seeking collaborators, innovators, and those who are driven to be their very best.

If you are looking for a career of purpose and are passionate about having an impact on society's health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.

About this role:

Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS
Job Function & Responsibilities
* Explain GCHP procedures, protocols, benefits, services and information to members, providers and advocates as required through incoming calls, emails, and other communication channels promptly and professionally.
* Provide members essential information regarding access to care, coordination of care, benefits, Evidence of Coverage (EOC), Member Handbook, etc.
* Troubleshoot and resolve escalated issues following established protocols and guidelines to escalate urgent matters or complex issues to appropriate personnel.
* Provide members with accurate information about eligibility, benefits, claim status, and authorization requirements.
* Process member ID card requests and perform other Member Services related tasks, functions, and special projects.
* Assist members and caregivers in scheduling appointments, coordinating referrals, and navigating healthcare services.
* Provide accurate and up-to-date information about medical procedures, services, and facilities.
* Collaborate with healthcare providers and internal teams to ensure efficient and accurate communication of member needs and information.
* Supports members in connecting with internal departments or external parties such as Community Supports, Primary Care Physician (PCP) offices, pharmacists, etc.
* Assist providers and members in using the Interactive Voice Response (IVR) and web portal.
* Ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. This includes adherence to compliance standards, confidentiality, and data protection regulations in all interactions and communications.
* Maintain an up-to-date and thorough knowledge of GCHP guidelines.
* Provide accurate research to resolve issues regarding eligibility, benefits, claims and authorizations using appropriate systems.
* Properly document all calls/contacts as required by department standards in a timely, clear, and concise manner using GCHP's internal tracking system.
* Review training/educational material and seek clarification when needed.
* Support robocall and ad-hoc member outreach activities as determined by business need.
* Achieve and maintain acceptable performance levels according to the Member Service standards.
* Access documents using Microsoft Office and other applicable software, as designated by management.
* Performs general clerical duties to include but not limited to photocopying, faxing, mailing, and filing.
* Document all calls, maintain accurate records, and update patient information in the system/database.
* Participate in training sessions to stay updated on medical procedures, services, and changes in healthcare policies.
* Serve members in a courteous and professional manner.
* Strive to achieve key performance indicators (metric goals) related to call handling, customer satisfaction, and service quality.
* Perform other duties as assigned.
* Understanding of D-SNP Model of Care: Gain knowledge of the D-SNP Model of Care, including social determinants of health impacting members enrolled in D-SNP.
* Coordination with Medicare and Medicaid: Provide assistance with navigating both Medicare and Medi-Cal benefits, ensuring members understand their dual eligibility and the services available to them.
* Specialized Training: Participate in specialized training programs required by CMS for D-SNP, ensuring compliance with annual training requirements.
* Issue Management: Handle issues involving dual eligibility, coordinating access to care across multiple providers and services to meet the unique needs of D-SNP members.

MINIMUM QUALIFICATIONS
Education & Experience:
* High School Graduate or General Education Degree (GED)
* Empathetic and patient-focused approach in dealing with diverse patient needs and inquiries.
* Proficient computer skills and familiarity with electronic health records (EHR) systems or customer relationship management (CRM) software.
* Ability to multitask, prioritize tasks efficiently, and work in a fast-paced environment.
* Excellent organizational skills and attention to detail.
* Willingness to work flexible hours, including evenings, weekends, and holidays as required.
* Ability to work collaboratively with others.
* Ability to answer a high volume of calls.
* Ability to be detailed oriented.
* Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities. Familiar with and be able to interpret policy and procedures.
* Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
* Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
* Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

KNOWLEDGE, SKILLS & ABILITIES
Preferred Qualifications:
* 1-3 plus years of experience in Customer Service
* Bilingual in English and Spanish.
* Contact center experience
* Experience in the health care field interacting directly with members.
* Direct experience with Medi-Cal guidelines and health insurance rules and regulations
* Prior experience in a healthcare setting, call center, or customer service role
* Strong communication skills, both verbal and written, with the ability to convey complex information in a clear and concise manner.

Technology & Software Skills:
* Advanced computer skills in MS Office products.
* Data entry experience with ability to type a minimum of 35 words per minute.

Certifications & Licenses: N/A

Competency Statements
* Accountability - Ability to accept responsibility and account for their actions.
* Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.
* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
* Communication, Oral - Ability to communicate effectively with others using the spoken word.
* Customer Oriented - Ability to take care of the customers' needs while following company procedures.
* Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

The estimated pay range for the position is:

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.