Medicaid Customer Service Representative

Job Title

Medicaid Customer Service Representative

Duration

Class starts: 10/21/2024

Description

Let’s do great things, together!

About ModaFounded 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. ​​​​Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Job Summary: This Medicaid Customer Service Representative I position requires working in a busy call center type environment with a high volume of calls. The position 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/OHP benefit plans. This position acts as a resource for members, providers, policyholders, hospitals, pharmacists and others regarding benefits or other issues. This position requires open availability 8am-5:30pm, Monday – Friday. Pay Range$18.03- $22.32. *Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range. Position starts October 21, 2024.

Please fill out an application on our company page, linked below, to be considered for this position: https://j.brt.mv/jb.do?reqGK=27740375&refresh=trueBenefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability

• 401K- Matching

• FSA

• Employee Assistance Program

• PTO and Company Paid Holidays

Requirements:

• High school diploma or equivalent.

• Minimum of one year of customer service experience working, preferably in health care or a health plan call center, or equivalent work experience and/or training.

• Practical knowledge of medical and/or pharmacy terminology desired.

• Knowledge of diagnosis and procedure coding desired.

• Claim processing experience or prior customer service experience or other related experience such as medical/dental office or pharmacy experience.

• Excellent oral and written communication skills.

• Ability to interact professionally, patiently, and courteously with customers over the phone and in person.

• Ability to articulate complex information in an easy-to-understand manner.

• Strong active listening skills and the ability to ask probing questions and understand concerns.

• Ability to work effectively with a team, and exercise sound judgment in handling assigned tasks including maintenance of strict confidentiality.

• Excellent interpersonal, written, and oral communication skills.

• Ability to demonstrate cooperation and teamwork.

• Good analytical and problem-solving skills.

• Type a minimum of 25 wpm net on computer keyboard.

• Ability to work well under pressure in a complex and rapidly changing environment.

• Ability to maintain agreed upon work schedule.

• Maintain confidentiality and project a professional business presence and appearance.

• Empathy/passion for working with disabled and low-income populations.

• Ability to work with multiple Pharmacy and Medical applications.

Primary Functions:

• Act as a member advocate and liaison with providers and partners as needed to ensure members are connected to services.

• Respond to and assist members and/or providers with Physical, Mental health plan assignments.

• Answer benefit questions from callers on Medicaid physical health, mental health, or pharmacy products. Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage and prescription drug benefits.

• Refer members to appropriate staff to assist with Non-Emergency Medical Transportation (NEMT) questions.

• Maintain confidentiality of information for all members.

• Research, verify and resolve inquiries relating to Oregon Health Plan and Medicaid eligibility.

• Work collaboratively with Oregon Health Authority, plans, providers, and members to ensure effective and timely follow-up of specific requests, issues, and problem resolution.

• 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.

• 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.

• Apply mathematical skills to determine correct benefit information.

• Exercise judgment, initiative, and discretion in confidential and sensitive matters.

• Provide proactive, value added service by identifying and reporting recurring issues.

• Use current technology and software to document all activities from any mode of communication from members, providers, and other customers.

• Consistently meet or exceed Moda standards and expectations including but not limited to quality, production, and attendance.

• Other duties as assigned

• Perform related duties

• Review, update and become familiar with new and revised benefit information or claim processing procedures.

• • Review and become familiar with changes in prescription benefits.

• Accurately apply Grievance and Appeal processes.

• Update and enter primary care physician selections.

• Request claim adjustments required because of error or new information.

• Perform other related duties as assigned.

• Provide customer service to walk-in members.

• Contact physicians, dentists, hospitals, pharmacies, and other providers when necessary to answer questions and obtain or provide information.

• Provide timely follow up and return calls when these are required.

​​​​​​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. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.