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Community Service Representative
2 months ago
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.
- EDUCATION
- Bachelors 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 - 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.
Qualifications
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.
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