Communicates internally and externally with members or clients to coordinate reports, data entry and tracking of tasks for various programs. Participates in non-clinical customer service for members or clients. Provides administrative support to staff. Works under general supervision.

• Identifies nature of issues, independently responds to and resolves non-clinical issues and complaints and escalates clinical issues to appropriate department and staff.
• Assists in monitoring member and client satisfaction through phone calls to verify service, answering questions and providing information. Documents service issues, identifies trends and recommends potential solutions.
• Maintains program specific expertise and organization structure. Acts as a resource to member or client.
• Serves as a resource in the resolution of member or client-related issues.
• Establishes effective customer-focused working relationships with members and/or clients, physicians, and providers of long-term care services.
• Participates in team meetings and provides input on customer service-related activities.
• Protects the confidentiality of member or client information and adheres to company policies regarding confidentiality.
• Ensures compliance with VNSNY policies and procedures as well as all Federal and State regulations.
• Participates in special projects and performs other duties as assigned.

For Partners in Care ONLY:

• Provides reports and analysis as required by the program.
• Works with team members to ensure that daily program tasks are completed including telephone calls to prospective program participants.
• Tracks visits scheduled and completed by clinical team and follows up on completion as needed.
• Coordinates telephonic intake and responses to both clinical and non-clinical customer service issues.

For CHOICE ONLY:

• Coordinates telephonic intake and scheduling of visits for clients.
• Works with members, providers, and staff to identify and resolve member service and retention related issues. Educates potential members/community representatives on plan features, plan benefits, and program admission requirements.
• Communicates with members and their families regarding information about MLTC services.

For CMHS ONLY:

• Monitors and tracks the progress of clients/members with complex psychiatric and/or co-morbid medical conditions.
• Educates potential clients/members on program features, benefits, and admission requirements.
• Tracks all medical, behavioral, substance use, and network referrals made for client/member; ensures that client/member follow up on referrals and attend scheduled appointments.
• Calls clients/members to remind them of important appointments and/or initial appointments to new service providers. Provides phone outreach to clients/members who have been non-compliant with necessary treatment appointments or have missed appointments for initial visits with new providers.
• Ensures that relevant team members receive important client/member alerts, including ED visits, hospitalization admission/discharge information, and other urgent notifications.
• Monitors client/member entitlements, insurance and benefits to ensure they remain in place. Alerts management when entitlements/benefits lapse, and assists management with reinstatement of discontinued benefits.

Licensure: Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.

Education: High School degree or equivalent required. Associate Degree in a healthcare related field preferred.

Experience: Minimum of two years of customer service experience required. Experience in a health care organization preferred. Proficiency in MS Word, Excel, and data systems required. General office experience including billing, accounts receivables and/or bookkeeping preferred. Bilingual skills may be required, as determined by regional/operational needs.