Alignment Healthcare is a privately held company that is on a mission to redefine “the business of healthcare” for senior citizens. As an employer, the comp
Outreach Concierge Navigator, Bilingual in Spanish
Location
North Carolina
Posted
2 days ago
Salary
$44.8K - $67.2K / year
Seniority
Entry Level
No structured requirement data.
Job Description
Outreach Concierge Navigator, Bilingual in Spanish
Alignment Healthcare
Outreach Concierge Navigator Bilingual in Spanish remote type Fully Remote locations Remote North Carolina time type Full time job requisition id R2069 The Remote Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. Supports our members to navigate through their health care and benefits. Connects the dots between our provider network, health plan operations, and supplemental vendors. Maintains a high knowledge of the member needs of their respective market and assist our members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. Lays the groundwork for future and ongoing member support. Has familiarity with assigned markets and understands the meaningful contributions to members’ healthcare outcomes. GENERAL DUTIES/RESPONSIBILITIES Provides in-market, specialized member support in respective market or region. Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery Conducts case follow-ups and quality member issue resolution for all cases assigned. Ensures members have access to PCP and specialists to coordinate care. Educates members on gaps in care and assists with scheduling provider appointments. Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures. Makes appropriate and timely patient appointments, reminders, and confirmations and Mails letters and correspondence as needed. Places regular/consistent outreaches to the patient Communicates with PCP with any member updates and requests. Assists with obtaining medical records from any healthcare providers involved in care or hospitals. Helps members with any authorizations and referrals involved in their care plan. Resolves 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. Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change). Other duties as assigned. Job Requirements: Experience: • Required: Minimum 1 year of customer service experience. • Preferred: 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. Education: • Required: High School Diploma or GED. Specialized Skills: • Required: - Knowledge of ICD-10 and CPT codes. - Keyboard typing 40+ words per minute. - Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. - Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. - Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; - 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. - 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. - Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly - Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. • Preferred: Bilingual English/Spanish or English/Vietnamese or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus. Licensure: • Required: None Work 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. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this 100% remote 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 talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 2 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $44,790.00 - $67,185.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
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Alignment HealthcareAlignment Healthcare is a privately held company that is on a mission to redefine “the business of healthcare” for senior citizens. As an employer, the comp
Customer Service Representative Bilingual in Spanish remote type Fully Remote locations Remote Arizona time type Full time job requisition id R1906 The Remote Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. Supports our members to navigate through their health care and benefits. Connects the dots between our provider network, health plan operations, and supplemental vendors. Maintains a high knowledge of the member needs of their respective market and assist our members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. Lays the groundwork for future and ongoing member support. Has familiarity with assigned markets and understands the meaningful contributions to members’ healthcare outcomes. GENERAL DUTIES/RESPONSIBILITIES Provides in-market, specialized member support in respective market or region. Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery Conducts case follow-ups and quality member issue resolution for all cases assigned. Ensures members have access to PCP and specialists to coordinate care. Educates members on gaps in care and assists with scheduling provider appointments. Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures. Makes appropriate and timely patient appointments, reminders, and confirmations and Mails letters and correspondence as needed. Places regular/consistent outreaches to the patient Communicates with PCP with any member updates and requests. Assists with obtaining medical records from any healthcare providers involved in care or hospitals. Helps members with any authorizations and referrals involved in their care plan. Resolves 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. Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change). Other duties as assigned. Job Requirements: Experience: Required: Minimum 1 year of customer service experience. Preferred: 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. Education: Required: High School Diploma or GED. Specialized Skills: Required: - Knowledge of ICD-10 and CPT codes. - Keyboard typing 40+ words per minute. - Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. - Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. - Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; - 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. - 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. - Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly - Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Preferred: Bilingual English/Spanish or English/Vietnamese or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus. Licensure: Required: None Work 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. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this 100% remote 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 talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 2 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $44,790.00 - $67,185.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
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