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Member Service Representative in Cypress, CA at Beacon Health Options

Date Posted: 12/6/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Member Services Representative to join our team at our office in Cypress, CA.  The Member Services Department is the front line interface to Members and Providers who seek information about behavioral health benefits. Member Services Representatives assist callers by providing benefit and eligibility information and referrals to network providers.  The Member Services Representative transfers clinical calls to clinicians, as defined in the department policies and procedures.  In addition, the Member Services Representative will be responsible for completing specified assignments that assist the department in meeting contractual goals.  
 

Position Responsibilities:

  • Answers intake ACD queues and adhere to telephone performance requirements for call response times and abandonment rates.
  • Responds to questions about eligibility, benefits and procedures for accessing behavioral health services.
  • Verifies patient benefits and eligibility through health plan computer access and phone.
  • Performs data entry and route calls to the appropriate resource. 
  • Determines which calls need to be transferred to a clinician, as defined by referral guidelines and established protocols.
  • Documents all call information according to standard operating procedures.
  • Checks personal voice mail and return calls within 1 business day.
  • Educates callers about Beacon/CHIPA services and their behavioral health benefits.
  • Follows health plan specific contract guidelines.
  • Attends all department and general staff meetings.
  • Forwards patient and provider complaints per health plan guidelines.
  • Identifies provider access problems on log that is reviewed by Network Development Committee.
  • Adheres to all Beacon policies and procedures and standards of operations.
  • Completes all required and assigned trainings.
  • Attend all mandatory company or department meetings.
  • Report to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Performs special projects and other duties as assigned and required.


Position Requirements:

  • 2 years call center experience, or 2 years customer service experience in an office setting
  • Prior Member or Customer Service experience preferred
  • Able to answer and resolve a high volume of member and provider calls effectively
  • Working knowledge of medical billing codes ICD9 / ICD10 and CPT coding a plus
  • Bilingual: Korean, Farsi, Vietnamese, Cantonese, and/or Spanish language skills a plus


TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
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