Contact Center Care Coordinator I

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP's focuses on 5 Core Values in the workplace:

* Integrity

* Accountability

* Collaboration

* Trust

* Respect

Disclaimers:

* Flexible work schedule is based on job duties, department, organization, or business need.

* Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

Gold Coast Health Plan is a leading healthcare organization dedicated to providing exceptional member care and support. We prioritize member well-being and aim to deliver high-quality member services through our dedicated team of professionals. As a Contact Center Care Coordinator I, you will play a pivotal role in ensuring seamless coordination and assistance for members seeking medical support and information.

The Contact Center Care Coordinator I is responsible for providing outstanding customer service and support to members, caregivers, and healthcare professionals who contact Gold Coast Health Plan. This role involves managing inbound and outbound calls, emails, and other communication channels to support members in accessing healthcare services, scheduling appointments, addressing inquiries regarding medical procedures, billing, and general information enrollment, eligibility, provider network authorization, plan guidelines and processes. This position handles inbound and outbound interactions involving member eligibility verification, general provider inquiries, claim status, general program and administration questions including direct member request for I.D cards and Primary Care Physician (PCP) changes, and triaging calls to appropriate units or outside entities. All interactions are documented in the system of record.

Work Schedule: 11:30am to 8pm Monday through Friday (remote), overtime as required.

Training Schedule: 8am to 5pm Monday through Friday (in office)

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

* Explain GCHP procedures, protocols, benefits, services and information to members, providers and advocates as required through incoming calls, emails, and other communication channels promptly and professionally.

* Provide members essential information regarding access to care, coordination of care, benefits, Evidence of Coverage (EOC), Member Handbook, etc.

* Troubleshoot and resolve escalated issues following established protocols and guidelines to escalate urgent matters or complex issues to appropriate personnel.

* Provide members with accurate information about eligibility, benefits, claim status, and authorization requirements.

* Process member ID card requests and perform other Member Services related tasks, functions, and special projects.

* Assist members and caregivers in scheduling appointments, coordinating referrals, and navigating healthcare services.

* Provide accurate and up-to-date information about medical procedures, services, and facilities.

* Collaborate with healthcare providers and internal teams to ensure efficient and accurate communication of member needs and information.

* Supports members in connecting with internal departments or external parties such as Community Supports, Primary Care Physician (PCP) offices, pharmacists, etc.

* Assist providers and members in using the Interactive Voice Response (IVR) and web portal.

* Ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. This includes adherence to compliance standards, confidentiality, and data protection regulations in all interactions and communications.

* Maintain an up-to-date and thorough knowledge of GCHP guidelines.

* Provide accurate research to resolve issues regarding eligibility, benefits, claims and authorizations using appropriate systems.

* Properly document all calls/contacts as required by department standards in a timely, clear, and concise manner using GCHP's internal tracking system.

* Review training/educational material and seek clarification when needed.

* Support robocall and ad-hoc member outreach activities as determined by business need.

* Achieve and maintain acceptable performance levels according to the Member Service standards.

* Access documents using Microsoft Office and other applicable software, as designated by management.

* Performs general clerical duties to include but not limited to photocopying, faxing, mailing, and filing.

* Document all calls, maintain accurate records, and update patient information in the system/database.

* Participate in training sessions to stay updated on medical procedures, services, and changes in healthcare policies.

* Serve members in a courteous and professional manner.

* Strive to achieve key performance indicators (metric goals) related to call handling, customer satisfaction, and service quality.

* Perform other duties as assigned.

POSITION QUALIFICATIONS

Competency Statements

* Accountability - Ability to accept responsibility and account for their actions.

* Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.

* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

* Communication, Oral - Ability to communicate effectively with others using the spoken word.

* Customer Oriented - Ability to take care of the customers' needs while following company procedures.

* Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

* Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

* Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

SKILLS & ABILITIES

Education: High School Graduate or General Education Degree (GED): Required

Experience:

* 1-3 plus years of experience in Customer Service strongly preferred.

* Bilingual in English and Spanish preferred.

* Contact center experience preferred.

* Health care field experience interacting directly with members preferred.

* Direct experience with Medi-Cal guidelines and health insurance rules and regulations is preferred.

* Prior experience in a healthcare setting, call center, or customer service role is preferred.

* Strong communication skills, both verbal and written, with the ability to convey complex information in a clear and concise manner.

Computer Skills:

* Intermediate computer skills included in the MS Office products.

* Data entry experience with ability to type a minimum of 35 words per minute.

Other Requirements:

* Empathetic and patient-focused approach in dealing with diverse patient needs and inquiries.

* Proficient computer skills and familiarity with electronic health records (EHR) systems or customer relationship management (CRM) software.

* Ability to multitask, prioritize tasks efficiently, and work in a fast-paced environment.

* Excellent organizational skills and attention to detail.

* Willingness to work flexible hours, including evenings, weekends, and holidays as required.

* Ability to work collaboratively with others.

* Ability to answer a high volume of calls.

* Ability to be detailed oriented.

* Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities. Familiar with and be able to interpret policy and procedures.

* Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.