Customer Services Specialist I

Program Description:
Enhanced Care Management (ECM) is a program within a far-reaching, multiyear plan to transform California's Medi-Cal system, known as California Advancing and Innovating Medi-Cal (CalAIM). Led by California's Department of Health Care Services, the goal of CalAIM is to help integrate Medi-Cal more seamlessly with other social services and help improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs. Customers enrolled in the ECM program receive comprehensive care management from a single System Navigator who coordinates all their health and health-related care, including physical, mental, and dental care, and social services. ECM makes it easier for customers to get the right care at the right time in the right setting and receive comprehensive care that goes beyond the doctor’s office or hospital. Come join our team, partnering with managed care health plans, and change the landscape of Behavioral Health and integrated care in our state!

What We Offer 

• The initial compensation for this position ranges from $22.31 to $27.44 an hour.   
• Salary is dependent on commensurate experience above the minimum qualifications for the role and internal equity considerations. 
• The salary may also vary if you reside in a different location than the location posted.   
• $80 per month Bilingual Stipend contingent upon Bilingual assessment completion.

Benefits We Offer   

• Benefits eligibility starts on day ONE!   
• We Offer Comprehensive Medical, Dental & Vision benefits, Voluntary Life Insurance, Flex Spending, Health Savings Account, EAP, and more!    
• Employer Paid Long-Term Disability & Basic Life Insurance 
• 401K Employer Match up to 4%
• Competitive Time Off Plans (may vary by employment status) 

JOB SUMMARY

Working within the vision, mission and philosophy of the agency, the Customer Service Specialist is responsible for processing and completing internal and external referrals, acts as primary liaison between external agencies and internal agency departments and completes all required administrative paperwork and data entry for customer records.  Coordinates all activities related to initial intake, level of care screening, insurance verification and payment coordination.  Regularly interfaces face-to-face and by telephone with customers as well as with all agency and County electronic systems connected to client care and billing.

RESPONSIBILITIES AND DUTIES

• Answers phones and obtains all information related to initial request for services, referral source, basic demographics, and insurance/payment responsibility
• Completes comprehensive phone screens and utilizes comprehensive knowledge of the Agency’s continuum of care to make initial referral recommendations  
• Answers questions regarding service availability
• Ensures that non-English language needs are met to facilitate effective access
• Creates electronic record and/or documents in other logs or databases as indicated
• Triages services to other community resources if applicable
• Maintains all tracking systems
• For foster youth, obtain qualifying minute order.  Also obtains other relevant court documents as needed.
• Verifies/clarifies insurance eligibility, co-pays, deductibles and enters into electronic record
• Coordinates with program manager, family, and billing re: payment issues
• Ensures that all initial and ongoing insurance authorization information is recorded in clinical record
• Liaison between all internal program departments regarding referral coordination
• Routinely maintains, verifies and confirms data entry accuracy and consistency between internal electronic records and all County systems
• Participates as member of team in QA/QI activities
• Prepares variety of reports as requested
• Works closely with Program Manager to continually build, improve, and refine Customer Services infrastructure
• Maintains expertise in agency-wide procedures
• To serve as back-up to any HIM and other Customer Services staff absences.  
• Other duties as assigned to support specific agency/business need and/or enhancement of operations

JOB SPECIFIC COMPETENCIES

• Advanced skills in Microsoft Office (e.g., Word, Excel, Project Management, etc.)
• Attention to detail
• Conflict Resolution 
• Documents Clearly and Accurately
• Encourages Customer Focus
• Time Management
• Strong communication skills

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each esse