Bilingual Member and Recipient Services Coordinator (Full time Remote, North Carolina based)

The Member and Recipient Services Coordinator provides a broad range of customer service functions to individuals that contact the MCO Call Center. MARS staff provide education regarding managed care, tailored plans, resources, services, benefit plans, service definitions, medical services, behavioral health services, DME, vision, and transportation services. MARS staff understand and clearly convey the variations and differences between Medicaid contract plans and state -funded services. MARS staff assure members/recipients/guardians seeking routine services are referred to services or are transferred to licensed clinicians for clinical screening and triage. Staff recognize and record consumer, provider, and stakeholder grievances. 

This position is full-time remote opportunity; Monday-Friday 9:30am-5:30pm. The selected candidate must reside in North Carolina.

 Responsibilities & Duties

Member and Recipient Education

• Receive calls from members, recipients, and community stakeholders
• Provide education to callers regarding all areas of MCO functions 

• Availability and appropriateness of contracted providers 

• General information about managed care and NC Medicaid Tailored Plans

• General information about state-funded services and NC Medicaid Direct 

• Benefit plans and member/recipient eligibility for services

• Choosing and changing member PCPs 

• Choosing and changing AMH+ and care management entities

• Role and expectation of care management entities

• Grievance and complaint procedures

• Navigating the Alliance Health website and member portal

• Eligibility and scheduling transportation

• Eligibility and referral for value added services

Call Management

• Engage in appropriate call management, based on information gathered, that may include, among other things:
• Escalation of urgent and emergent calls to a licensed clinician
• Complete routine screening and referral a timely manner
• Records grievances resolved and/or pending resolution
• Use standardized decision tools to effectively route calls as needed
• Ensure that I/DD service requests are triaged correctly and referred to I/DD Access Coordinators
• Receive, answer and record provider inquiries in MCO tracking system
• Assist callers with addressing obstacles to accessing care and identifies available resources
• Engage in follow-up activities to ensure consumers were seen for scheduled assessments and schedule aftercare appointments
• Route incoming calls to appropriate Tailored Plan departments when inquiries cannot be adequately addressed at the Call Center level
• Reschedule missed appointments
• Document all incoming call activity in the appropriate software program

Customer Service

• Report patterns of atypical call and service seeking patterns to supervisor
• Maintain calm, helpful, appropriate demeanor and decision-making for all callers, regardless of presentation
• Continue work efforts without interruption while managing technological 
• disruptions and outages
• Simultaneously operate and navigate a multi-function phone system with multiple software programs while managing caller needs; serially operate and navigate multiple software programs in course of all duties
• Read, integrate, and adapt procedural tasks in a rapidly changing, paperless work environment
• Work independently to prioritize tasks and maintain idle status in call queue during high call volume and/or low staffing periods
• Simultaneously operate and navigate a multi-function phone system with multiple software programs while managing caller needs; serially operate and navigate multiple software programs in course of all duties
• Thoroughly train incoming staff to job duties and provide additional training to staff throughout clinical operations in the functions of the call center
• Interact with community services orally while receiving information orally and in writing via IM, when called upon to do so
• Engage interpreter services when needed and adjust communication accordingly
• Perform job functions during inclement weather and on assigned holidays
• Master troubleshooting of hardware and multiple software programs, including security protocols, VPN, and software behind the firewall
• Maintain basic office skills such as navigating software, searching relational databases, and entering data accurately and efficiently
• Other duties as assigned by supervisor

Minimum Requirements

Bachelor’s degree in a Human Services or related field and a minimum of four (4) years of experience in a community, business or governmental program that