Clinical Services Associate

US-NY-New York
1 week ago
Job ID
2017-10851
# Positions
1
ArchCare Advantage
Experience (Years)
1
Category
Administrative
Work Days Per Week
5
Shift
D
Shift Start Time
9:00 AM
Shift End Time
5:00 PM
Type
Full-Time
# Hours
35

Overview

The Clinical Services  Associate will assist in the functions of MLTC Clinical assessments Department on a daily basis, collaborating with all other departments. The associate must have strong organization skills and have the ability to work on multiple assignments and complete them within established time deadlines. The associate will work with the enrollment department, provider relations, quality assurance and clinical teams to complete tasks as needed. This position will report directly to the Clinical Assessments Supervisor.

Responsibilities

Prepare regularly scheduled reports required for individuals, departments, and management associates.

Complete Enrollment Calls with Maximus/potential member for applicants in accordance with NYS Medicaid regulations and ensuring accuracy of data entry and submission

Answer incoming calls from members and providers.

Accurately record all information in company formatted computer systems or manual files as needed.

Using good written and verbal communication, works effectively with Clinical Assessments Supervisor and other departmental staff. Supports ArchCare objectives and works actively to create and perpetuate a team environment.

Use problem-solving skills to determine and resolve various issues

Ensure quality and accuracy throughout all processes. Communicates with third party vendors, members, providers and regulatory agencies as needed to ensure integrity of data housed in Managed Care information system.

Reconcile Weekly, Monthly member assessment reports from internal staff and vendors to maintain accurate tracking of assessment dates of completion.

Prepare reconciliation adjustments and correct errors as needed in a timely basis.

Cross train with other health plan department’s staff and Managers to ensure optimum customer satisfaction, quality and compliance.

Performs at all times in compliance with all company rules, state and federal regulations and laws and in keeping with the traditions, mission and ethical boundaries of the Catholic Health Care System and its programs

Provide help and advice to customers and providers, using the organization's products or services

Communicating courteously with customers, providers and vendors by telephone, email and face to face.

Investigating and solving provider inquiries and customer problems, appeals and grievances.

Ensure that follow up on complaints and grievance is being completed and documented as assigned. Bring problems with follow up to attention of Director of Operations and Director of Quality.

Document all calls and in appropriate area of the management information system.

Strong interpersonal skills and ability to interact and work with staff at all levels.

Extensive ability with MS Office suite (Word, Excel, Outlook)

Ability to work independently and in team environments, to promote cooperation and team work among peers, superiors and customers.

Have the initiative and ability to demonstrate ultimate concern for the customers, anticipating their needs and going beyond their expected levels of service.

Performs all other duties as assigned.

Qualifications

Formal Education: High School Diploma or equivalent

License, Registration, and / or Certification Requirement: No

 

Education Desired


 

*

Bachelor’s degree or extensive relevant experience strongly preferred

 

Experience Desired


 

*

Bachelor’s degree or extensive relevant experience strongly preferred

*

A minimum of 3-5 years’ experience in managed care preferred

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