Community Service Representative

3 days ago

Chula Vista, United States Community Health Group Full time

POSITION SUMMARY

Addresses and resolves provider issues and ensures providers are kept up to date on policies/procedures and any contractual changes. Coordinates provider education and training. Provides information and education on Medi-Cal managed care and Community Health Group (CHG) to Medi-Cal beneficiaries, community-based organizations and the general public. Cultivates and sustains positive working relationships with providers and with community organizations serving potential members. Enrolls Medi-Cal beneficiaries interested in joining CHG.


COMPLIANCE WITH REGULATIONS

Works closely with all necessary departments to ensure that utilization management processes, programs and services are accomplished in a timely and efficient manner. Works in accordance with CHG policies and procedures, and in compliance with applicable state and federal regulations, including CMS, DMHC and DHCS.


RESPONSIBILITIES

Enhances the visibility of the organization by making individual and group presentations, and outreach to providers, provider staff and staff of community organizations.

Establishes and maintains positive relationships and open lines of communication with providers to ensure concerns are addressed on a timely basis by visiting assigned provider sites on, at a minimum, a weekly basis.

Addresses and resolves provider issues related to day-to-day operations.

Provides and interprets information, updates, and alerts to ensure providers are effectively informed on various procedures/issues related to Claims, Customer Service, HEDIS and others.

Works with Claims, Customer Service, Contracting and other departments to ensure provider issues related to contract terms and rates are resolved and administered correctly.

Implements plan policies and procedures and provides input on revisions to policies related to providers.

Promotes CHG's Medi-Cal health plan by organizing and participating in community health fairs and other events.

Enrolls Medi-Cal beneficiaries interested in joining CHG.

Supports team effort by performing other duties as assigned or requested; participating in meetings and on committees; attending work shops, training and seminars; continues professional development; networking; following corporate, division, personnel and safety policies and procedures.

Maintains product and company reputation and contributes to the team effort by conveying professional image at all times.

Conduct provider surveys over the phone or onsite.

Conduct Health Risk Assessment calls as needed.



EDUCATION

Bachelor’s degree preferred.


EXPERIENCE/ SKILLS

Current CA driver's license, proof of auto insurance and working car.

One year successful sales experience.

Two year successful community outreach experience, preferably related to Medi-Cal and/or Medicare.

Knowledge of Medi-Cal managed care plan eligibility requirements and Community Health Group programs and services.

Familiarity with community social service organizations and groups.

Bilingual ability in Spanish or Vietnamese required.

Self-directed; ability to recognize and capitalize upon opportunities to promote CHG programs and services in many different venues.

Knowledge of Microsoft programs (Word, Excel, Access, etc.)

Excellent written, verbal and telephone skills.

Ability to analyze program requirements and regulations, understand contract language and educate providers on related issues.

Able to manage multiple tasks simultaneously.

Ability to identify issues and resolve complex problems with internal and external customers.

Conducting successful sales presentations.

Making individual and group presentations.

Ability to prepare materials and train staff.


PHYSICAL REQUIREMENTS

  • Frequent driving
  • Public speaking.
  • Will be required to work evenings and/or weekends and to carry needed equipment for community events, in personal car (e.g., canopy, helium tank(s), materials, etc.).
  • Lifting and carrying up to 30 lbs.



Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action


The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

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