Customer Solution Center Even MORE Service Liaison I

Salary Range:  $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.)

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
 

Job Summary

The Customer Solution Center (CSC) Even MORE Service Liaison I communicates to members in all lines of business (LOB) regarding: welcome and outbound calls, member Health Risk Assessment, and other related programs. The Liaison conducts and documents outreach activities (call, web, email) consistently and accurately. The Liaison proactively identifies, documents, investigates, and resolves member issues in a timely and appropriate manner. The Liaison also identifies potential areas of membership dissatisfaction and recognizes improvement areas.

 

The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:

   * Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services (CMS), and for Seniors and Persons with Disabilities (SPD) population.

   * Contact members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information is not provided on choice forms, enrollment applications, and data transmissions from applicable sources, etc. as well as the preferred threshold language and/or alternative format for receiving their welcome kits, network-related member notification letters, etc.

   * Collaborate with internal and external stakeholders and members to facilitate continuity of care and the related enrollments and assignments (based on enrollment information for Covered California, permission-to-enroll forms, daily updates from PASC, COBRA/ICP elections, etc.)

   * Process and screen applications and renewals for Healthy Kids members, notify applicants of the disposition of their application/renewal, and conduct the appropriate follow-up (including review of vendor outreach efforts)

   * Work with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.

   * Collaborate with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, Personal Assistance Services Council (PASC), third party liability constituency, etc. staff to address and resolve questions, issues, etc. regarding member demographic information (e.g., CIN, name, address, and other related information) so that it can be appropriately updated and reflected in the system. Liaison also attends and participates in various internal and external meetings in this regard.

Duties

Facilitate the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirement for Health Risk Assessments for Medicare Plus DSNP members and SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This is aligned with service level requirements. (40%)

 

Track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. Assist with coordinating with other departments to follow up and resolve issues that arise through member contact, including potential care coordination/continuity of care issues. (20%)

 

Meet L.A. Care’s policy and procedure (P&P) requirements for attendance and follow department guidelines and expectations. Collaborate with the CSC Departments regarding member enrollment efforts for all lines of business. (15%)

 

Assist with identifying and assessing areas of potential member dissatisfaction (PQI) as well as focusing on opportunities for service/process improvement. This is in compliance with regulatory requirements for auditing purposes. (10%)

 

Assist Business Units and Product Lines with the implementation and completion of special