Job Information
InnovaCare Customer Service Rep - Temporary * Programa de Referidos * in San Juan, Puerto Rico
LE0002 MMM Holdings, LLC
It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
MMM Holdings, Inc.
Job Description
BUSINESS UNIT: MMM Holdings, LLC
DEPARTMENT: Service Operations Department - Call Center
POSITION: Customer Service Representative
REPORTS TO: Customer Service Supervisor
CLASSIFICATION: Non Exempt
POSITION DESCRIPTION
This position is responsible to serves as primary liaison between enrolled beneficiaries, provider network and MMM & MSO, for the purposes of provide orientation, issues resolution, and provider satisfaction.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Provides member/provider materials upon request; acts as primary liaison between both of them. Provides ongoing telephone orientation regarding policies and procedures to our members, providers or office staff. Assures coverage of Service Operations Department call center during normal operating hours. Documents calls and issues in C3PO application. Coordinates / advocates resolution of Member and Provider issues and concerns. Provides support to all the Contact Center Units in order to make members and provider inbound/outbound calls to educate, and bring issue resolution. Process Member and Provider requests accordingly of Departamental policies. Accomplish established metrics by the Contact Center Management on a daily, weekly and monthly basis. Forwards performs and/or processes orientations regarding disenrollment, cancellations, reimbursements, outbound calls, Member/Provider satisfaction surveys, etc. Maintain themselves in continuously learning environment with update information arriving through trainings, emails, one on one’s, staff meeting and any other way. Manage CTI system in a daily basis.
12.Report any unusual situation identified at the time of the member or provider contact.13.Notify supervisor of any processes not in compliance with the Plan’s SNP policies and MOC requirements.
Manage and identify CMS Audit calls. Manage contacts requesting Interpreter Services. All staff will adhere to all operational policies and procedures related to the SNP product. Staff will attend to trainings per MOC guidelines related to functions of enrollment, customer service, provider relations/contracting or credentialing as applies. Special projects as assigned.
EDUCATION AND EXPERIENCE
Associate degree in health or business related field.
Minimum one year of experience in a healthcare or Call Center environment. Prefered someone with health plan, medical billing or customer service experience.
Evidence of good communication, interpersonal and problem‑solving skills.
GENERAL ABILITIES AND KNOWLEDGE
Computer literate, preferably in the following applications: Word, Excel and Outlook.
Ability to respond to a high volume of work and maintain a polite and professional manner at all times.
Able to function with frequent interruptions.
Ability to prioritize workloads for maximum efficiency.
Able to sit for extended periods of time without compromising work performance.
Customer Service Skills: practicing, valuing and supporting service to both internal and external customers
Time Management Skills: establishing priorities and accomplishing tasks in a timely manner
Team Work: ability to work in a team environment to create solutions to problems
Fully Billingual (English and Spanish), preferable.
GENERAL SKILLS
Have strong interpersonal skills.
Excellent verbal and written communication skills.
English literate.
Typing Skills
Multiple Task: Ability to write and maintain in the call focuses at the same time
LANGUAGE SKILLS
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
REASONING ABILITY
Ability to apply common sense understanding to carry out instructions furnished in written or oral form, detailed but not complicated. Ability to deal with problems involving few concrete variables in standardized situations.
PHYSICAL AND MENTAL DEMANDS
Position requires sitting and standing associated with a normal call center environment. Regularly talks and hears. This position requires that weight be lifted or force be exerted up to 10 pounds.
ENVIRONMENTAL AND WORKING CONDITIONS
Working on normal call center environment is required. The noise is typically moderate. Evening or weekend work, as necessary. Working flexible work hours; depending operational needs.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Innovacare, Inc. is the leading provider of healthcare management in North America. Through two it’s main ways, Medicare Advantage and the provider network, we are committed to healthcare, creating models that are sustainable, cost-effective, and fully integrated with the most advanced technologies. Innovacare, Inc. combines innovation and quality care to create progressive, value-based models, even for the neediest patient populations. Our leadership team, with its vast years of combined experience in managed care and care delivery, is made up of leading experts with proven experience to help healthcare organizations effectively meet and exceed the growing demands of our industry.
InnovaCare Health's foundation was laid by President and CEO Richard Shinto, M.D., in 1998, when he joined North American Medical Management (NAMM) in California. Over the next 10 years, the company continued to grow, acquiring MMM Healthcare in Puerto Rico. In December 2012, the management team successfully sold select NAMM properties and officially formed InnovaCare Health to operate the remaining subsidiaries, including MMM. MMM Holdings, is a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Más (MMM), and for the beneficiaries of the government health plan with MMM Multihealth. Through InHealth Management, it manages the in-hospital care of the beneficiaries, while the specialized clinics, MMM Vita Care, serve members with chronic conditions. On the other hand, MSO of Puerto Rico supports medical groups, providers and other entities in the health industry, while Castellana Physicians Services is a medical group dedicated exclusively to providing services for the elderly and disabled population in Puerto Rico.
At the same time, the main company manages Medicare and Much More, a Medicare Advantage population health plan with a presence in Miami-Dade, Broward and Palm Beach counties. With a Mobile Application that allows members to check the status of their pre-authorizations, access their provider directory and schedule their future medical visits, Medicare and Much More integrates technology as a tool to improve the member experience. Also, the plan will ensure the health of members, during and after natural disasters. Through the Florida MMM Line of Care, as a Part D sponsor, you will ensure that the member has adequate access to their covered Part D drugs.
Orlando Family Physicians, a group of clinics that provide comprehensive care services in the state of Florida, is another of the companies managed by Innovacare, Inc. With more than 20 years of service in the Central Florida community and more than 100,000 patients cared, Orlando Family Physicians offers the personalized treatment and care that the patient deserves. With a track record that proves excellent customer service, we are proud that the largest Hispanic medical group in Central Florida has joined us. Our constant growth is the best witness we have to tell that things are being done well, so it is our commitment to continue on this path.
Innovacare, Inc. es el proveedor líder de manejo de servicios de salud en Norteamérica. A través de dos principales vías, Medicare Advantage y la red de proveedores, estamos comprometidos al cuidado de la salud, creando modelos que son sostenibles, costo-efectivos y completamente integrado a las tecnologías más avanzadas. Innovacare, Inc. combina innovación y atención de calidad para crear modelos progresivos y basados en el valor, incluso para las poblaciones de pacientes de mayor necesidad. Nuestro equipo de liderazgo con sus vastos años de experiencia combinada, en atención administrada y prestación de atención, está formado por expertos preeminentes con la experiencia comprobada para ayudar a las organizaciones de atención médica a satisfacer y superar eficazmente las crecientes demandas de nuestra industria.
Las bases de InnovaCare Health fueron establecidas por el presidente y CEO Richard Shinto, M.D., en 1998, cuando se unió a North American Medical Management (NAMM) en California. Durante los próximos 10 años, la compañía continuó creciendo, adquiriendo MMM Healthcare en Puerto Rico. En diciembre de 2012, el equipo de gestión vendió con éxito propiedades selectas de NAMM y formó oficialmente InnovaCare Health para operar las filiales restantes, incluida MMM.
MMM Holdings, es un conglomerado de compañías que trabaja las estrategias de negocio de Puerto Rico, tanto para Medicare Advantage, a través de Medicare y Mucho Más (MMM), como para los beneficiarios del plan de salud del Gobierno con MMM Multihealth. A través de InHealth Management maneja el cuidado intrahospitalario de los beneficiarios, mientras que, las clínicas especializadas, MMM Vita Care, atienden afiliados con condiciones crónicas. Por otro lado, MSO of Puerto Rico apoya grupos médicos, proveedores y otras entidades en la industria de la salud, mientras Castellana Physicians Services es un grupo médico dedicado exclusivamente a proveer servicios para la población de edad avanzada y discapacitada en Puerto Rico.
A su vez, la compañía matriz maneja Medicare and Much More, plan de salud para la población Medicare Advantage con presencia en los condados de Miami-Dade, Broward y Palm Beach. Con una Aplicación Móvil que permite a los afiliados verificar estatus de sus pre-autorizaciones, acceder su directorio de proveedores y agendar sus futuras visitas médicas, Medicare and Much More integra la tecnología como una herramienta para mejorar la experiencia del afiliado. También, el plan velará por la salud de los afiliados durante y después de desastres naturales. Por eso, a través de la línea de cuidado MMM de Florida, como patrocinador de la Parte D, se asegurará de que el afiliado tenga acceso adecuado a sus medicamentos cubiertos de la Parte D.
Orlando Family Physicians, grupo de clínicas que brindan servicios para el cuidado integral en el estado de la Florida, es otra de las compañías manejadas por Innovacare, Inc. Con más de 20 años de servicio en la comunidad de Florida Central y más de 100.000 pacientes atendidos, Orlando Family Physicians ofrece el tratamiento personalizado y la atención que el paciente merece. Con una trayectoria que prueba un excelente servicio al cliente, estamos orgullosos de que el grupo médico hispano más grande en Florida Central se haya unido a nosotros. Nuestro constante crecimiento es el mejor testigo de que las cosas se están haciendo bien por lo que es nuestro compromiso continuar por ese camino.