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SalaryYour career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Responsibilities:
Reporting to the Supervisor of Medicare VIP Concierge Services, the Concierge Service Outreach Administrator is a highly motivated, extremely effective service specialist, responsible for completing Welcome Calls, conducting STARS/HEDIS outreach, researching, and following up with hard-to-reach members via phone to provide targeted, personalized concierge level service to AmeriHealth members.
The Concierge Service Administrator’s job is to reach members who are either new, have gaps in care, or reach members to engage, consult, and educate based on unique needs, preferences, and understanding of the AmeriHealth plan to help guide the member to quality and timely care.
The Concierge Service Outreach Administrator may support STARS, Medical Management, Member Services, Quality Team, and other teams as deemed appropriate.
Through various research methods, the Concierge Service Outreach Administrator will support the development of and execute outreach strategies for the purpose of impacting health outcomes and member engagement to establish and ensure that a trusted relationship with the member occurs.
The Concierge Service Outreach Administrator will ensure that timely introduction to the plan occurs, schedule monthly contact with high-risk members, contact identified members with Care Gaps/HEDIS-related health conditions, and assist them in accessing care through plan benefits and community resources. The Concierge Service Administrator will handle all in/outbound calls and transactions, directly supporting assigned groups with problem resolution and educational materials while developing strategies to increase healthcare adherence to reduce barriers to care and promote retention. Additional duties include:
- Research members that are hard to locate by using various methods and search engines.
- Management of the customer relationship by providing customized interaction based on member needs creating a connection to ensure retention and maintain member loyalty.
- Provide member education and counseling on access to services, benefits, and providers.
- Resolve member concerns providing resolution within expected or required timeframes.
- Complete welcome calls for the members who are newly enrolled with the plan, including scheduling an initial assessment for Medical Management as required by contract.
Complete appointment assistance and follow-up for identified members. - Maintain a working knowledge of Plan Benefits and Services.
- Responsible for record-keeping, documenting call dispositions, and/or compiling and generating reports as required.
- Assume ownership and responsibility for member satisfaction with AmeriHealth during every successful member contact and remove barriers to care.
- Address member concerns, fully assist and answer questions related to member and provider resources, benefits, enrollment, HEDIS preventative services, member bills, LTSS services and other questions that may arise during their 1 year with the plan and/or while included in a certain member group.
- Conduct outreach calls for assigned projects as needed.
- Ability to identify member needs beyond the initial inquiry, including the ability to provide solutions to concerns regarding food resources, shelter resources, additional plan details, etc.
Collaborates with colleagues to deliver a VIP Experience for members. - Identify trends and any emerging customer service issues that might impact member satisfaction.
Education/Experience:
- Associate degree preferred or 2 years of equivalent work experience.
- Minimum of 1 year of Customer Service in a healthcare setting.
- Minimum of 1 year working knowledge of Managed Care, Medicare, or Medicaid.
- Minimum of 1 year of health care in an office/clinic/hospital setting or human services experience.
- STARS or HEDIS knowledge preferred.
- Proficient PC skills with Microsoft Office Suite (Word, Excel, etc.).
- Excellent problem-solving and organization skills.
- Ability to work independently or as a team.
- Ability to navigate through multiple software systems simultaneously.
- Strong interpersonal communication skills.
- Ability to maintain positive relationships with both internal and external customers.
- Ability to work before/past normal shift hours to complete any outstanding task(s) for members.
- Attention to detail and accuracy.
- Ability to work one Saturday per month.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
