Virtual Concierge Navigator, Medical Assistant

Virtual Concierge Navigator, Medical Assistant Position Summary: The ACCESS On-Demand Concierge is Alignment Healthcare's model to ensure best-in-class service and care coordination 24/7. As a member of this team, you will be at the center of our member experience and the face of Alignment Healthcare. You will provide members with "White Glove" service and act as a guide to help our members navigate their virtual experience and health care overall. The Virtual Concierge Navigator ensures member satisfaction and customer service are provided at the level of excellence that our members deserve. To do so, you will become an expert on our health plan and supplemental benefits, care deliver model, and provider network; you will also serve as the liaison among members, providers, and internal departments. By ensuring an "aligned" experience is available to our members at any time of day or night, over the phone, through video-chat, and messaging. Essential Duties and Responsibilities: Essential duties and responsibilities of the Virtual Concierge Navigator include, but are not limited to: Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries; serve as a "subject matter expert" in the health care experience that our members navigate daily. Resolve incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member's primary care physician and proactively engage member with their wellness plan options. Collaborate with our partners - including but not limited to other departments, supplemental benefit vendors, and provider network - to facilitate the member experience. Responsible for receiving inbound phone calls within the department's goal timeframe; may be required to communicate with members in other channels including e-mail, web chat, SMS/text, as required. Manage to the member's communication preferences as possible, which may include time of day, channel, and language; utilize interpreter service as needed. Responsible for real-time documentation (i.e., caller name, contact info, call reason, action taken, resolution, etc.) and timely wrap-up to support outcomes reporting, in all systems/applications as required. Provide administrative support to virtual providers with referrals and initiating authorization requests as deemed appropriate, following up to ensure completion. Coordinates member's care for PCP care plan, diagnostic tests, radiology, laboratory, and specialty appointments. Ensures appointments are scheduled and confirmed with the member via Alignment's EMR system; confirms demographics entered are complete. Schedules transportation as appropriate. Manage appropriate clinical escalations and triage; link the member to appropriate clinical resources. Verify the member is included in or targeted for any outreach or care gap programs and connect members to programs (such as chronic disease programs) or services when appropriate. Analyze available programs, determine program eligibility, and assists with enrollment of such program as appropriate. Monitor communication channels as assigned and manage replies to ensure all metrics for timeliness and member experience success are met. Develop, write, and edit digital replies, which may involve coordination of health plan benefits knowledge, reference documents, member resources, insights from key stakeholders, and more to be determined. Follow communication "scripts" and/or templates as appropriate, ensuring the consumers' needs are clearly understood and resolved. Excel in customer service and contribute to a culture of going "above and beyond" to ensure the highest level of member satisfaction. Adhere to all applicable attendance policies to ensure consistent and reliable queue coverage, which is essential to the member experience. Supervisory Responsibilities This job has no supervisory responsibilities. 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 diploma or general education degree (GED). 2. Certificates, Licenses, Registrations: Medical Assistant Certification. Required. 3. Other Qualifications: Medical front/back office experience. Knowledge of ICD-10 and CPT codes. High-volume inbound customer service experience, particularly for health plan or Medicare "Member Services" roles in health plan and supplemental benefits. Preferred. Telemarketing and/or member outreach experience. Preferred. Specialized experience in escalation or resolution units. Preferred. Skills and Abilities 1. Communication Skills: Strong communication skills via email and phone. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus. 2. 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. 3. Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance. 4. Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. 5. Computer Skills: Strong computer skills. 6. Other Skills and Abilities: a. Computer literate, typing 40+ words per minute. b. Excellent communication skills, oral and written. c. Must pass a writing test. Impeccable grammar and spelling. Please note: No time off granted during Onboarding/Training and for Jan 1 - Jan 30, 2021 due to high call volume for calendar year enrollment. Must be willing to work overnight, weekends, and holidays as scheduled. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. 2. The employee is frequently required to walk; stand; reach with hands and arms. 3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. 4. The employee must occasionally lift and/or move up to 20 pounds. 5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Working Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. The noise level in the work environment is usually moderate. 2. Remote, work from home positions available. Apply tot his job Apply To this Job