Communication Center Representative

Overview: The Communication Center Representative will either work in SME (Supplemental Member Engagement - Direct to Member Communication) or MRR (Medical Record Review direct to medical facilities) and can be moved between lines of business when business needs change.

SME

Communication Center Representatives will conduct scheduling of appointments with client members. The Representative must enjoy speaking with people (particularly the elderly) on the phone and possess the in-depth understanding and the diverse skills to overcome member issues, hesitation or objections. The Communication Center Representative is accountable for making a high volume of calls with exceptional member service and ability to convert phone calls into scheduled visits while upholding strong metrics and quality.

MRR

The Communication Center Representative in the MRR (Medical Record Review) department, our mission is to perform out-reach to hospitals, providers, and providers offices to retrieve medical charts for the Health Plans membership. The Communication Center Representative will perform research, identify location of charts for requests, and assist in the collection of the charts while upholding strong metrics and quality.

Duties and Responsibilities:

SME specific Duties & Responsibilities:

• Conduct outbound/inbound calls to health plan members to schedule in-home assessments by nurse practitioners or other clinical staff;
• Provide members with full details of the in-home assessment within guidelines of clients;
• Provide friendly customer service with a positive attitude, building rapport and trust with members;
• Present, promote, and sell benefits of in-home assessment through active listening skills, empathy, and the ability to overcome objections;
• Scheduling Specialist may also work to schedule appointments for client's members in a physician's office or minute clinic;

MRR specific Duties & Responsibilities:

• Conduct outbound/inbound calls to Provider's Office to verify location of the Health Plans member's medical records for future Medical Records Request.
• Research Provider Information to obtain alternate contact information to locate member's medical records.
• Provide Provider's Offices with all record retrieval options and schedule the return of medical charts accordingly.
• Provide friendly customer service with a positive attitude, building rapport and trust with Provider's Offices using active listening skills, empathy, and the ability to overcome objections;
• Required to log all activities with attention to detail.

Applicable to Both Roles:

• Maintain compliance with Complexcare Solutions policies, procedures and mission statement
• Adhere to all confidentiality and HIPAA requirements as outlined within ComplexCare Solutions Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and
• Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Employer.

Job Requirements:

• Must possess strong computer literacy skills, including, but not limited to, data entry and retrieval, and Microsoft Office;
• Bilingual strongly desired;
• Experience in a high call volume inbound/outbound call center or like environment;
• Ability to work in a fast-paced environment, prioritize tasks to meet deadlines and goals, perform additional duties as directed by management, and meet all business expectations in metrics and quality;
• Must be able to adapt to change to meet business and client expectations weekly, monthly, yearly;
• Excellent verbal and written communication skills;
• Sales experience strongly desired;
• Strong interpersonal and organization skills;
• Comfort level working with the senior citizen population;
• Knowledge of healthcare or managed care highly preferred; and
• Ability to exercise independent judgement within policy and procedure guidelines established by the company.

Education:

• High school diploma or equivalent is required.

Physical Demands and Work Environment:

• Sedentary work (i.e. sitting for long periods of time);
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
• Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;
• Subject to inside environmental conditions; and
• Travel for this position will include less than 5%, typically for training purposes.