Assist in the coordination of essential PACE services and promote participant satisfaction and retention via consistent, high quality, customer service skills. Focus is on assisting participants with inquiries, services requests, eligibility issues, complaints, and appeals.
Responsibilities also include documentation and processing of incident reports, documentation and coordination of disenrollments, as well as facilitation of on-site satisfaction surveys. Works collaboratively with interdisciplinary teams to achieve program and organizational goals while adhering to established state and federal regulations.
Provide excellent customer service to internal/external customers in efforts to ensure a satisfactory participant experience in the PACE program through use of AltaMed's service recovery model. Interface with contracted providers and government agencies (DPSS, LACDHS) and complete any case management tasks necessary to identify and release Medi-Cal hold status and Medicare interruptions, in order to assure continuous PACE enrollment.
Receive service quality complaints and grievances and work to resolve them in a timely manner using ALTA service recovery strategies and in accordance with policies and procedures. Document and complete participant incident reports, collaborating with Interdisciplinary Team to ensure effective reporting, follow up, and resolution. Lead retention team efforts to identify service delivery issues/concerns, and minimize disenrollments.
Process internal and external service denial appeals by assuring proper documentation in accordance with policies and procedures, and follow up through to resolution. Ensure accurate and timely documentation in participant electronic medical record and other appropriate databases/trackers Perform audit surveillance tasks as assigned to monitor adherence to established protocols, policies, and procedures. Attend monthly Participant Advisory Council meetings and other meetings as assigned.
Coordinate on-site participant surveys, make recommendations regarding strategies for improvement of the participant's experience, and lead process improvement efforts as assigned. Other duties as assigned.
High School diploma or equivalent with a minimum of 2 years' customer service experience required. Bachelor's degree preferred.
Knowledge of Medi-Cal, Medicare, Social Security benefits is required; PACE program knowledge is preferred. CPR/First Aid certificate is required. Experience in PACE operations, managed care operations, or in other healthcare settings serving the frail or elderly is preferred. Bilingual: Spanish/English, Chinese/English or another second language is strongly preferred.