Member Care Representative

Member Care Advocate – LA/IE/SD Liaison

Description:

Member Care Advocate – LA/IE/SD Liaison works in conjunction with the territory Account Executives to ensure that the contracted physicians in the assigned territory receive the member care support needed to achieve company set goals. 

Essential Duties and Responsibilities

Essential Duties and responsibilities include, but are not limited to:

1. Conduct onsite outreach campaigns for assigned providers while maintaining a minimum 85% completion rate. Outreach Campaigns consist of the following items but not limited to:

a. Initial Health Assessment

b. Annual Health Assessments

c. STAR / HEDIS Measures

d. Medication Adherence

e. Risk Adjustment Related Projects

f. Member retention

2. Visit providers offices to review Annual Health Assessment documents, payments, and related information.

3. Drop off or collected signed agreements between PCAC and network specialist or PCP.

4. Coordinate with Account Executives to schedule and attend In-service training. Trainings consist of the following but not limited to:

a. Billing In-Service

b. Annual Health Assessments In-Service

c. Coding In-Service

d. Portal In-service 

5. Ensure that all providers interactions are properly documented in CRM System with accuracy and detail.

6. Escalate all concerns from provider offices to Account Executives or members of management as needed.

7. Coordinate/Participate in company and provider events. Events consist of the following, but not limited to:

a. Physician Health Fairs

b. Marketing events

c. PCAC company hosted events.

d. Agent/FMO hosted events.

8. Conduct member home visits as needed to ensure that campaign goals are met.

9. Properly document the progress of each assigned provider to update management team required time frame.

10. Use Cozeva to document all member interaction.

11. Collaborate with QI department team members (Account Executives, PL Team, Medication Adherence, Member Care Advocates) for campaigns associated to assigned providers.

12. Be able to review and explain all company related documents.

13. Ensure that provider visit schedules are completed by the assigned time.

14. Escalate physician office concerns in a professional fashion and ensure that they have been addressed.

15. Report member related issues or concerns in a timely manner and ensure that concerns are resolved.

16. Ensure that Member/Provider visit schedules are added to the company calendar and completed by assigned time.

17. Perform other duties and responsibilities as needed.

Member Care Advocate Liaisons are required to visit a minimum of 5-10 physician offices per week within designated territory. Visits must be planned with the direction of Account Executives or Management team.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Education and/or Experience: High School or general education degree (GED); or on to three months related experience and/or training; or equivalent combination of education and experience.

2. Medical Assistance Certificate: Not required but preferred.

3. Phlebotomy License: Preferred but not required.

Other Qualifications :

1. Two years customer service experience

2. Health Plan Outreach Experience

3. Direct member communication, preferably in the Medi-Cal, Commercial, or Medicare Managed Care industry preferred.

4. Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans preferred.

5. Bilingual (English/Spanish) required.

Skills and Abilities

1. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

2. Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10s and 100s. Ability to perform these operations using units of American money and weight measurement, volume and distance.

3. Reasoning Skills: Ability to apply common sense understanding to carry out detailed but variables in standardized situations.

4. Computer Skills: Strong computer skills.

Other skills and Abilities

· Computer literate. Typing 40+ words per minute.

· Excel proficiency

· Excellent communication skills, oral and written.