Medicare Health Care Concierge - (Menasha) in Appleton, Wisconsin For Sale

Network Health's success is rooted in its mission to enhance the life, health and wellness of the people we serve. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Medicare Healthcare Concierge who will support multiple Medicare products (Platinum Plus, Platinum Premier, Network Cares and NHP Select Choice) for benefit interpretation, claims, authorizations and member inquiries. Receives telephone inquiries from Members, Agents and Providers. Meets with members as needed. Performs outbound calls to members for relationship management and specific issue resolution. Assigned a list of members to manage. Provides excellent service to internal and external customers through a demonstrated commitment to Network Health Mission and Values. A qualified candidate will have a desire to work with a "values driven" organization while having the ability to communicate effectively, remain organized, and have ability to apply analytical thinking to identify and solve problems. Essential Duties and Responsibilities: Medicare Concierge must maintain knowledge of all existing and new Evidence of Coverage for all Medicare products. Ability to professionally work with members, providers, agents and designated parties with regard to verification of benefits, claim and membership inquiries. This includes being responsible for investigating discrepancies and solving any issues that may occur. Ability to establish rapport with a broad spectrum of customers, maintaining proper voice tone and language in accordance with caller's level of understanding, and to ensure proper customer perception. The Medicare Concierge is responsible for complete and accurate documentation of all inquiries received ensuring accurate and timely responses are provided according to departmental guidelines. Ability to work well within the department and with other departments to determine how to resolve a call in the best interest of the member while maintaining the Network Health Plan Evidence of Coverage. The Medicare Concierge must have the ability to thoroughly investigate and respond to member inquiries. If member satisfaction is not achieved and the member chooses to file a grievance/appeal the representative is responsible for completing the appropriate paperwork, document all files, and forward the request to the appropriate personnel for resolution. Medicare Concierge must maintain knowledge of ESI, TMG, Care Management and member software used, to be able to complete the request from the caller. Works with member financial and medical information. Confidentiality is required at all times. Assists walk in members to resolve inquiries. This includes being responsible for investigating inquiries and resolving issues that may arise. The Medicare Concierge is responsible for managing the relationship with their assigned members. This includes outbound calls once per quarter (once per month for Special Needs Plan members) to every assigned member. Skills Required: Knowledge of medical terminology preferred. Excellent organizational and prioritization skills. Effective verbal and written communication and interpersonal skills, ability to perform multiple tasks, knowledge of insurance principals including Medicare products, critical thinking and problem solving skills. Minimum Education Required : High School diploma or equivalent, Associate Degree preferred. Minimum Related Years of Experience ( per minimum education ) Required: Two or more years of customer service experience within the health insurance industry preferred. Experience working with Medicare products and population preferred. If no health insurance experience, must have at least 5-7 years of experience providing phone customer service support. Company Description: Ministry Health Care is a network of hospitals, clinics, and other health related organizations operating across the central, northern, and northeastern regions of Wisconsin and eastern Minnesota. To meet the needs of the communities we serve, we offer a complete continuum of care through acute and tertiary care hospitals, physician clinics, long-term care and assisted living facilities, home health agencies, hospices, and numerous other programs and services.
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