(Internal Only) Medicare Csr Iii -Work From Home (Ak, Id, Or Or Wa)

Job Title
(INTERNAL ONLY) Medicare CSR III -Work From Home (AK, ID, OR or WA)
Duration
Open Until Filled
Work From Home
Yes
Description
(INTERNAL ONLY)
Let’s do great things, together.
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.This Medicare Customer Service Representative III position requires working in a very busy call center type environment with a very high volume of calls. The person in this position has interactions throughout the day with teammates as well as other Moda employees and external customers. The Customer Service Representative is the initial point of contact and provides superior customer service by demonstrating a high degree of courtesy, accuracy, and professionalism to members of Medicaid, Medicare and PERS benefit plans. This position acts as a resource for members, providers, policyholders, hospitals, pharmacists and others by analyzing caller’s needs and providing timely and accurate responses. The position requires open availability 7am-8pm, 7 days a week.This position starts on August 14th 2023.
Benefits

• FSA
• Employee Assistance Program
• Medical, Dental, Vision, Pharmacy, Life, & Disability
• PTO and Company Paid Holidays
• 401K- Matching

Schedule

• Availability between 7:00 am - 9:00 pm Monday - Friday
• PST

Required Skills, Experience & Education

• Experience as a Moda CSR II consistently performing at an overall satisfactory level of performance for a minimum of 6 months. Moda III designation may also be obtained through equivalent work experience and knowledge level at Moda.
• Ability to interact professionally, patiently, and courteously with customers over the phone and in person.
• Type a minimum of 25 wpm net on computer keyboard.
• Good analytical and problem-solving skills.
• Ability to work with multiple Pharmacy and Medical applications.
• Practical knowledge of medical and/or pharmacy terminology desired.
• Ability to demonstrate cooperation and teamwork.
• Claim processing experience or prior customer service experience or other related experience such as medical/dental office or pharmacy experience.
• Excellent interpersonal, written, and oral communication skills.
• Empathy/passion for working with disabled and low-income populations.
• Excellent interpersonal, oral and written communication skills.
• Ability to work well under pressure in a complex and rapidly changing environment.
• Ability to articulate complex information in an easy-to-understand manner.
• Maintain confidentiality and project a professional business presence and appearance.
• Ability to work effectively with a team, and exercise sound judgment in handling assigned tasks including maintenance of strict confidentiality.
• Ability to maintain agreed upon work schedule.
• Strong active listening skills and the ability to ask probing questions and understand concerns.
• Knowledge of diagnosis and procedure coding desired.
• High school diploma or equivalent.

Primary Functions

• Answer claims and benefit questions from callers on Medicare and Medicaid physical health, mental health, or pharmacy products.
• Respond to and assist members and/or providers with Physical, Mental health plan assignments.
• Act as a member advocate and liaison with providers and partners as needed to ensure members are connected to services.

Provide solutions to problems, research, verify and resolve eligibility queries, explain benefits and/or plan coverage and prescription drug benefits.

• Work collaboratively with vendors, plans, providers, and members to ensure effective and timely follow-up of specific requests, issues, and problem resolution and provide information on community resources when appropriate.
• Apply mathematical skills to determine correct benefit information.
• Maintain confidentiality of information for all members.
• Provide proactive, value added service by identifying and reporting recurring issues.
• Cross trained onto EOCCO Medical and Pharmacy and OHSU Medicaid Medical lines of business
• Assist with Medicare Welcome Calls
• Cross trained onto Pharmacy Medicare line of business
• Ability to repeatedly analyze situations, communicate effectively, in a fast-paced environment that includes effective conflict resolution skills.
• Provide accurate information in a professional manner and maintain current knowledge and skills.
• Refer Medicaid members to appropriate staff to assist with Non-Emergency Medical Transportation (NEMT) questions.
• Use current technology and software to document all activities from any mode of communication from members, providers, and other customers.
• Exercise judgment, initiative, and discretion in confidential and sensitive matters.
• Consistently exceeding Moda standards and expectations including but not limited to quality, production, and attendance.
• Work collaboratively with Oregon Health Authority, plans, providers, and members to ensure effective and timely follow-up of specific requests, issues, and problem resolution.
• Other duties as assigned.
• Availability to work 7:00 am – 8:00pm, 7 days per week
• Collaborate with others inside and outside of Health Share to explain benefits not covered by Oregon Health Plan and provide information on community resources when appropriate.
• Cross trained onto Moda and Pers Supplement lines of business
• Cross trained onto Moda and Summit Medicare Advantage lines of business

Perform Related Duties

• Request claim adjustments required because of error or new information.
• Update and enter primary care physician selections.
• Provide timely follow up and return calls when these are required.
• Review, update and become familiar with new and revised benefit information or claim processing procedures.
• Contact physicians, dentists, hospitals, pharmacies, and other providers when necessary to answer questions and obtain or provide information.
• Review and become familiar with changes in prescription benefits.
• Provide customer service to walk-in members (if assigned and working in the office).
• Accurately apply Grievance and Appeal processes.

Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.
For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our [email protected] email.
Pay Range
¤18.00
Hourly to ¤19.79
Hourly