SCOPE OF POSITION:
Responsible to serve as the liaison between recipient/family issues with Primary Care Physicians assignments. Provide communication, education and promotion of the PCCM program. Collaborate with medical and other professional staff to meet contract deliverables within designated timeframes. Responsible to assist recipients/families with changing their initial auto-assignment and annual re-enrollment assignment in a managed care dental plan. Shall support enrollment of all newly eligible clients in a managed care dental plan. Serve as a subject matter expert on assigned contract deliverables. Ensure timely provision of services and appropriate follow up. Document services rendered and report as required.
ESSENTIAL JOB FUNCTIONS:
- Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment. Knowledge should include information regarding contract, contract deliverables, policies and procedures, resources available, and technology to perform the processes required to complete each task.
- Responsible for the resolution of customer/client requests including research, referral, policy review, documentation and follow up in accordance with established policy/procedures.
- Communicate effectively with customers and/or recipients. Develop and maintain working relationships as necessary to meet contract deliverables of specialty area project.
- Maintain knowledge of functionality of equipment, programs and requirements to meet contract deliverables as scheduled.
- Maintain knowledge in other areas of Member Services to assist as needed with the overall operation of the Member Services department.
- Daily quotas may be added to meet contract deliverables as needed.
- Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
- Communicate needs and requests to other team members as appropriate.
- Ensure compliance with AFMC policy, contractual obligations, state and federal laws and regulations and compliance documentation.
- Comply with AFMC QA/QC Standards of Excellence when interacting with a customer.
- Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
- Additional duties as assigned.
Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.