Member and Recipient Services Coordinator (Full-Time Remote, North Carolina Based)

The Member and Recipient Services Coordinator provides a broad range of customer service functions to individuals that contact the Tailored Plan (TP) Member and Recipient Services Call Center. This position provides general information regarding accessing services in the TP provider network, and on the various functions and processes of TP departments. This position assures consumers/guardians seeking routine services are referred to services or are transferred to licensed clinicians for clinical screening and triage.

This position will be equipped with all supplies and technologies to be able to work from home. The candidate should have a private/personal designated workspace. The selected candidate must reside in North Carolina.

Responsibilities and Duties

Customer Service & Support

• Receive calls from members, recipients, and community stakeholders
• Provide education to callers regarding all areas of TP functions
  • Availability and appropriateness of contracted providers;
  • General information about managed care and NC Medicaid Tailored Plans;
  • General information about state-funded services and NC Medicaid Direct;
  • Benefit plans and member/recipient eligibility for services;
  • Choosing and changing member PCPs;
  • Choosing and changing AMH+ and care management entities;
  • Role and expectation of care management entities;
  • Grievance and complaint procedures;
  • Navigating the Alliance Health website and member portal;
  • Eligibility and scheduling transportation; Eligibility and referral for value added services
• Maintain calm, helpful, appropriate demeanor and decision-making for all callers, including angry, abusive, threatening, and harassing callers

Initial Coordination & Triage

• Escalate urgent and emergent calls to a licensed clinician
• Complete routine screening and referral a timely manner

Consumer Scheduling

• Assist callers with addressing obstacles to accessing care and identify available resources
• Engage in follow-up activities to ensure consumers were seen for scheduled assessments and schedule aftercare appointments
• Reschedule consumer missed appointments

Documentation & Reporting

• Record consumer demographics in electronic health record (EHR)
• Record grievances resolved and/or pending resolution
• Receive, answer and record provider inquiries in EHR
• Document all incoming call activity in EHR
• Report patterns of atypical call and service seeking patterns to supervisor

Adhering to Workflow

• Continue work efforts without interruption while managing technological disruptions and outages
• Operate and navigate a multi-function phone system with multiple software programs while managing caller needs
• Operate and navigate multiple software programs …