About the Role:
DWGAS is looking for self-motivated and enthusiastic Member Relations to join our team. The perfect candidate will cooperate with the Provider Relations in building and maintaining effective relationships with the external vendors and patients.
Essential Duties and Responsibilities:
• Keep a pulse on quality control metrics, identifying areas for improvements within the Member Services team and with other departments.
• Deliver various projects including scheduling, communicating, coordinating, development, and evaluation.
• Consults with members to direct them into appropriate programs, interpreting and educating members’ benefits.
• Develop/Utilize monitoring systems, tools and processes to evaluate and improve the quality of services delivered within the Member Relations department.
• Establishes and coordinates with Supervisor of any issues, complaints, grievance and appeal.
• Create resolution process to monitor, track, report, and improve patient satisfaction.
• Identifies initial and continuing eligibility for DW contracted entity(s) by screening and interviewing patients to assess financial and payor source status.
• Responsibilities include financial screening and enrollment for State and County health programs, verifying Medicare, Medi-Cal, HMO, PPO, and other payment sources.
• Handling Medicare or Medicare Advantage and Part D questions; easing overall departmental workflow; and treating all clients with courtesy, and respect.
• Assists with problem solving, decision making and improvement of managed care portal including training, provisioning, workflow and functionality.
• Build member loyalty by retaining, promoting and facilitating health plan enrollments.
• Maintains member confidence and protects information according to HIPAA regulations to prevent or detect unauthorized disclosure of protected health information.
• Maintains and committed to provide excellent customer service that reflects the mission and value of the organization.
• Performing outgoing calls and existing members requiring assistance and reaching out to members who may be at potential risk for membership issues.
• Performing any additional/miscellaneous duties(not inclusive of job description) as requested by the Health Supervisor within the scope of knowledge/ability.
• Ensures activities are performed in compliance with company policies and procedures as well as state and federal laws and regulations.
• Bachelor’s Degree preferred, diploma or equivalent required.
• Minimum experience of 2 years in healthcare member services.
• Fluent in English with excellent oral and written communication skills.
• Bilingual in Korean/Tagalog/Japanese/ Mandarin required.
• Exceptional customer service, communication, and conflict resolution skills with knowledge of appropriate techniques to address members from diverse social and ethnic groups.
• Ability to make decisions in the absence of detailed instructions and be able to work both independently and in a team environment.
• Ability to make proper judgment calls and understands when to escalate to supervisor when issue raises
• Exceptional time management skills with the ability to meet production guidelines, prioritize work and keep focused in a fast-paced environment.
• Ability to reach goals with minimal supervision.
• Experience using Microsoft (MS) Office-PowerPoint, Excel and Word, etc
• Ability to lead and coordinate team members and system users.
• Ability to prioritize multiple tasks and complete work under pressure of deadlines and resource constraints.
• Experience with business writing and excellent verbal communication skills
• Strong analytical and problem solving skills
• Ability to multi-tasks and juggle multiple jobs
For more information about Trivium, visit www.trivium.com Interested applicants may forward a résumé, cover letter and references to the attention of Ramya at firstname.lastname@example.org.
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: poster_screen_reader_optimized.pdf