Manager, Member Services

3 weeks ago

Los Angeles, United States Regal Medical Group, Inc. Full time
Job Description

Position Summary:

Manager Customer Service (Call Center) will assist with overseeing the day-to-day operations of all call center activities, provide supervision to call center staff, and provide guidance to the staff as applicable

Assist with resolving complex issues and handle escalated calls that a Customer Service Representative Supervisor or a Customer Service Representative Lead are unable to resolve. Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability. Assists the team in carrying out department responsibilities and collaborates with Director to support short and long-term goals/priorities for the department. Assist with setting priorities for the team to ensure task completion and performance goals are met, such as average speed of answer, abandonment rate, service level, average handle time, quality, and staff schedule adherence. Assist with resolution of authorizations, eligibility, billing and health plan inquiries and complaints relating to RMG policies and procedures.

Essential Duties and Responsibilities include the following:

  • Assist with overseeing the work of all employees to ensure they work productively and meet deadlines and company standards
  • Answering telephone calls and emails from member and health plans
  • Ensures timely response to inquiries and/or complaints from callers.
  • Interfaces with members and providers who had unsatisfactory experience with medical services or RMG procedures.
  • Participates in meetings to create, analyze, apply, interpret and/or communicate policies, procedures and regulations effectively.
  • Support company activities such as company goals/strategy and management meetings as required.
  • Assist with ensuring the establishment and compliance of departmental goals and for implementing procedures and performance standards to achieve these goals.
  • Review telephone system statistics periodically throughout the workday to manage call volume.
  • Assist with Interviewing, promotion, employee performance evaluations, training, motivation, counseling and discipline of assigned employees.
  • Assist with department reporting as required.
  • Handle and document resolution of escalated/high profile calls to promote customer satisfaction.
  • Assist with monitoring Customer Service Inquiries by type of reason to evaluate and return inappropriate issues to the department supervisor to educate Customer Service Staff.
  • Provide Customer Service activity reporting to Sr. Director as required.
  • Recommend process improvements based on call tracking and trending reports.
  • Implement and coordinate issue resolution processes.
  • Proven good communication, interpersonal, and conflict resolution skills
  • Works independently and is able to take on multiple tasks.
  • Follow HIPAA guidelines with all information pertaining to member medical information and privacy.
  • Excellent organizational skills and ability to multitask and juggle multiple priorities
  • Display warm and pleasant phone personality, emphasizing tact, empathy and patience.
  • Display professionalism, good judgment, maturity, and fairness when interacting with others.
  • Prioritize assignments and other work functions in order to maintain workflow.
  • Maintain or exceed quality and productivity standards for the Member Service representatives.
  • Overflow call handling
  • All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $70,304.00 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

  • Employer-paid comprehensive medical, pharmacy, and dental for employees
  • Vision insurance
  • Zero co-payments for employed physician office visits
  • Flexible Spending Account (FSA)
  • Employer-Paid Life Insurance
  • Employee Assistance Program (EAP)
  • Behavioral Health Services

Savings and Retirement:

  • 401k Retirement Savings Plan
  • Income Protection Insurance

Other Benefits:

  • Vacation Time
  • Company celebrations
  • Employee Assistance Program
  • Employee Referral Bonus
  • Tuition Reimbursement
  • License Renewal CEU Cost Reimbursement Program
  • Business-casual working environment
  • Sick days
  • Paid holidays
  • Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements

Education and / or Experience:

  1. Degree in Healthcare Administration.
  2. Managed 3 to 5 years' experience at a Medical Group, Health Plan Customer Services or Medical office is required.
  3. Strong knowledge of Medi-Cal, Medicare Managed Care Plans required
  4. Demonstrated knowledge of CMS Call Center Metrics, CAHPS, NCQA guidelines etc
  5. Strong proficiency with Microsoft Office applications, specifically Word Outlook and internet applications
  6. Possess Excellent written and verbal communication skills
  7. Self-starter with strong analytical, critical thinking, problem-solving, leadership, and relationship-building skills
  8. Strong interpersonal skills and a collaborative management style
  9. Ability to prioritize work in order to meet daily deadlines
  10. Ability to deal responsibly with matters of a confidential nature.
  11. Able to write policies and procedures and correspondence
  12. Able to speak effectively before groups of customers or employees of the organization
  13. Knowledge of HMO, DHS, DMHC and CMS regulatory guidelines.
  14. Knowledge of CPT-4, HCPCS, Hospital Revenue, and ICD-9 coding.
  15. Knowledge of HMO, DHS, DMHC, and CMS claims processing guidelines.
  16. Strong knowledge of Microsoft Windows environment such as Word and Excel.
  17. Self-starter, willing to take on multiple tasks.
  18. Strong analytical skills.
  19. Must be able to review and interpret health plan benefits and provider contracts.
  20. Able to interact with customers both internal and external of RMG.
  21. Ability to communicate effectively orally and written typing 45 words per minute.
  22. Strong organizational skills with emphasis on prioritizing and attention to details.
  23. Presentation Skills
  24. Strong Technical Skills
  25. Ability to run reports
  26. Ability to create training materials.
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