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Network Service Representative

MetroPlus Health Plan New York, NY

  • Expired: over a month ago. Applications are no longer accepted.
Job Description
About NYC Health + Hospitals

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

The Network Service Representative provides comprehensive customer service to members, providers and prospective members. The primary responsibilities include but are not limited to answering and responding to all customer inquiries and complaints, documenting all customer contacts into the tracking system, conducting outreach, assisting in PCP selection, conducting new member orientations.

Job Description
  • Receive and respond to, either in person or on the phone, inquiries and complaints from members, providers, regulators, the general public and staff related to issues such as provision of health services, eligibility, rosters, access to care, disenrollment, authorization, benefits, claims, applications for membership, questions about recertification etc.
    • Verify member eligibility in internal databases (i.e., Powerstep) or through HRA and SDOH (via ePaces/EMEVs)
    • Document all encounters and calls in MACESS
    • Issue temporary ID cards
    • Verify member demographic information with face-to-face interactions
    • Assist in review of patient profiles and conduct follow up on required member demographic issues
    • Conduct PCP changes for members
    • Assist with prospective member inquiries regarding application status (via ANY)
  • Outreach to members, in person or on the phone, on issues such as orientation to plan services, benefits, primary care provider assignment, health  assessments, appointments, demographics, applications and recertification and retention, utilization, etc.
    • Conduct new member orientations
    • Follow up on problematic cases or for member related issue resolution.
    • Follow up on appointment reminder
  • Record all encounters in the tracking system in a timely manner and assure that they are followed to resolution.
  • Special assignments as requested
Minimum Qualifications
  • Bachelor's Degree, preferably in health care administration, marketing, or a related area of study, and a minimum of one (1) year experience in a managed care or provider organization or,
  • An equivalent combination of training or education and experience in related fields can be substituted for educational requirements
  • Minimum of one year of experience in direct consumer contact, sales, and/or social services or a satisfactory equivalent combination of education, training and experience.
  • Bilingual is preferred

Professional Competencies 

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Written/Oral Communications

MetroPlus Health Plan

Address

New York, NY
USA

Industry

Business

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