Cencal Health
Job Details
Job Location
Main Office - Santa Barbara, CA
Position Type
Full Time
Salary Range
$84877.00 - $123072.00 Salary/year
Job Category
Member Services
Description
Central Coast Salary Range - $84,877 - $123,072
Candidates for this position must reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties) or be willing to relocate to the area upon hire. As a community-facing role, a local presence is essential to effectively engage with and serve our community. Please note that relocation assistance may be available.
Job Summary
Expectations of this position are to ensure that CenCal Health's Call Center staff within a queue environment meets or exceeds all objectives and goals relating to Call Center Service Level Metrics and Standards as established by regulatory, contractual requirements, Department Director, and Quality Committees as appropriate. This position also provides for the daily oversight and supervision of the Member Services Representatives, hiring, mentoring, evaluations, terminations including appropriate staffing and supervisor coverage for the telephone queue. This position will ensure service to CenCal Health's membership and its provider network that is aligned with the Plan's strategic goals and mission statement. In this role, the Supervisor will provide guidance regarding complex issues requiring an in-depth knowledge of all CenCal Health programs and benefits. The incumbent must be a positive team member contributing to the successful and cohesive unit.
Duties and Responsibilities
The Call Center Supervisor is a role model for the Leads, Senior and Member Service Representatives (MSRs) in helping them build their skill set while supervising their daily activities ensuring that the Department workload is completed in a timely manner and meets established goals for service and quality standards related to established metrics. This position must demonstrate a thorough understanding of CenCal's various healthcare program benefits and any applicable co-payments, eligibility, dual and OHC coordination of benefits, coordination with the local government and Community Based Organizations (CBO) agencies, pharmacy formulary, and provider network workings which include but are not limited to the following:
Knowledge / Skills / Abilities
Eligibility and its nine sub-screens
CalSAWS
Adjudication
Member Grievance - COG
HIS-Call Tracking System
Provider
Cisco Agent Desktop
Medslite
RBM
Authorization Processing (TAR)
Calabrio
Problem Claim Check
Standard Report
Procedure
Claim Search
Veritas Reporting
Call Tracking
Job Location
Main Office - Santa Barbara, CA
Position Type
Full Time
Salary Range
$84877.00 - $123072.00 Salary/year
Job Category
Member Services
Description
Central Coast Salary Range - $84,877 - $123,072
Candidates for this position must reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties) or be willing to relocate to the area upon hire. As a community-facing role, a local presence is essential to effectively engage with and serve our community. Please note that relocation assistance may be available.
Job Summary
Expectations of this position are to ensure that CenCal Health's Call Center staff within a queue environment meets or exceeds all objectives and goals relating to Call Center Service Level Metrics and Standards as established by regulatory, contractual requirements, Department Director, and Quality Committees as appropriate. This position also provides for the daily oversight and supervision of the Member Services Representatives, hiring, mentoring, evaluations, terminations including appropriate staffing and supervisor coverage for the telephone queue. This position will ensure service to CenCal Health's membership and its provider network that is aligned with the Plan's strategic goals and mission statement. In this role, the Supervisor will provide guidance regarding complex issues requiring an in-depth knowledge of all CenCal Health programs and benefits. The incumbent must be a positive team member contributing to the successful and cohesive unit.
Duties and Responsibilities
The Call Center Supervisor is a role model for the Leads, Senior and Member Service Representatives (MSRs) in helping them build their skill set while supervising their daily activities ensuring that the Department workload is completed in a timely manner and meets established goals for service and quality standards related to established metrics. This position must demonstrate a thorough understanding of CenCal's various healthcare program benefits and any applicable co-payments, eligibility, dual and OHC coordination of benefits, coordination with the local government and Community Based Organizations (CBO) agencies, pharmacy formulary, and provider network workings which include but are not limited to the following:
- Primary role in the hiring and termination of Call Center staff.
- Responsible for the coordination with the Member Services Trainer for training and in-servicing needs and oversight of new and established Call Center staff.
- Monitor and evaluate 6-month introductory performances and annual reviews to ensure continuous performance of the Call Center Team based upon established goals and assignments.
- Establish and maintain effective working relations with the Call Center Team by establishing weekly meetings to discuss any issues and or provide updated information.
- Establish and maintain monthly one on ones with Call Center Team to discuss monthly metrics, provide positive feedback and or coaching if needed.
- Monitor calls and perform PCP audits handled by the MSR's, based upon established goals and assignments, in collaboration with the Call Center Manager, Call Center Supervisors, and Member Services Trainer.
- Provide guidance to the Sr. and line staff requests for assistance as appropriate in responding to escalated member issues, difficult calls or situations as prescribed by the Call Center Manager and/or Director.
- Work with Call Center Manager and Sr. Manager to ensure a continuously improving workflow process, identify needs and make recommendations tothe Director.
- Identify and make recommendations regarding policies/procedures and assist the Associate Director and MS Trainer in updating applicable department policy and procedures as they relate to the Call Center.
- Identification and resolution of Health Information System programming issues or need for improvements related to the Eligibility, PCP Selection Screen, COG and various screens used by the Call Center staff.
- Establish and maintain effective and cooperative working relations with internal health plan staff, outside collaborative agencies such as DSS, Public Health Department, Tri-Counties Regional Centers, California Children's Services, Public Authority, Alcohol Drug and Mental Health for SB County and Mental Health Services for SLO County, and network providers by providing guidance and coaching for the Call Center staff.
- Provide assistance all call center staff in identifying, triaging and transitioning continuity of care issues; selection of Primary Care Providers (PCP); explain program/benefits and make referrals to other programs, Community Based Organizations and services, as appropriate.
- In collaboration with the Member Services Training Manager, Associate Director and Director participate in the review and updating of all Call Center Training Guide and associated materials and manuals.
- Collaborate with the appropriate staff in order to provide statistical information for Call Center per established protocols as required.
- Perform other duties or special projects as assigned.
- Participate on various workgroups, quality committees as assigned by Member Services Call Center Manager and/or Director.
- In collaboration with the Member Services Call Center Manager, report updated demographic information to the Department of Social Services such as address changes, DOB corrections, name corrections and income updates and any member eligibility issues.
- In collaboration with the Member Services Call Center Manager, Associate Director, Trainer and Data Analyst, provide assistance to the CenCal Health compliance team with auditing of provider calls when necessary.
- Oversight of member portal communications from membership. Review, respond and update all member portal tickets and messages received.
- Oversight of member portal account issues; unlocking and updating member portal accounts when members are unable to log in.
- Direct interaction with the Member Services Data Analyst to review Call Center metrics to ensure quality of care of our members and to meet regulatory guidelines.
- Ensures that the Call Center Team is always appropriately staffed to assist our members/providers and to meet the Call Center metrics. Monitors day to day scheduling of staffing within the call center.
Knowledge / Skills / Abilities
- Demonstrate a thorough understanding and knowledge of CenCal's various healthcare program benefits and any applicable co-payments, eligibility, coordination with duals and OHC, coordination with the local government and CBO agencies, specific to individual Program benefits and understanding of the Plan Provider Network requirements necessary to the coordination of care with Plan providers;
- Must have extensive knowledge of Medi-Cal eligibility related issues, DSS, SSA, TCRC inter-workings, and an understanding of the State's beneficiary assignment and processes as they relate to the Plan;
- Must demonstrate strong supervisory and interpersonal skills; ability to communicate effectively both orally and in writing; demonstrate good judgment in making decisions within the scope of the position; For those bilingual positions, must be fluent in Spanish per testing results by Plan consultant;
- Demonstrate a complete knowledge and functionality of the Plan's HIS screens noted below:
Eligibility and its nine sub-screens
CalSAWS
Adjudication
Member Grievance - COG
HIS-Call Tracking System
Provider
Cisco Agent Desktop
Medslite
RBM
Authorization Processing (TAR)
Calabrio
Problem Claim Check
Standard Report
Procedure
Claim Search
Veritas Reporting
Call Tracking
- Strong communication, interpersonal and relationship building skills.
- Able to multi-task in a fast-paced environment. Strong time management skills.
- Strong analytical and problem solving skills.
- Proven superior customer service experience and orientation.
- Proficiency in Word, Excel, Power Point.
- Strong organizational skills.
- AA degree and a minimum of five (5) years of experience in a managed health care customer service call center environment or equivalent related experience six years(6 years) in a Managed Care environment.
- Knowledge of public assistance or human services programs.
- Knowledge of the Medi-Cal, Social Security, and all aspects of the Call Center position.
- Strong analytical, organizational and decision-making skills related to customer service.
- Ability to manage multiple priorities and meet deadlines.
- Good oral and written communication skills.
- Ability to process a high volume of work and assume special projects over and above assigned responsibilities.
- Bilingual required.