Conducts telephonic outreach to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have. Assists in scheduling doctor appointments via three-way phone calls and assists in scheduling transportation services, if needed. Maintains confidentiality of business and protected health information.
Reports To: Supervisor, Patient Care Advocacy
Department: Health Services - Quality & Analytics
Position Location: Houston, TX 77081
- Conducts telephonic outreach to members to support Quality Improvement, regulatory and contractual requirements.
- Educates the member and their family about preventive health screenings while identifying barriers to care.
- Schedules doctor appointments for all household members with care gaps with the Primary Care Physician (PCP) and/or Specialist to access needed preventive care services and close gaps in care via a three-way phone call.
- Informs providers about the care gap(s) member has and why they are seeing the provider.
- Arranges transportation for members as needed.
- Documents all actions taken regarding contact related to member.
- Interacts with other departments including Customer Service to resolve member issues.
- Refers to CM/DM as appropriate.
- Completes special assignments and projects instrumental to the function of the department.
- Performs other duties as assigned.
Education: High School Diploma. Associate's Degree or Bachelor's Degree strongly preferred
Experience: 1-2 years' experience in member, provider and customer service or call center environment. Health coaching experience a plus. Some understanding of medical terminology. Experience in managed care helpful. Appreciation of cultural diversity and sensitivity towards targeted populations.
Special Skills (e.g. 2nd language):
Bilingual skills (English and Spanish) a plus.
Excellent communication skills required.
Data Entry skills
Ability to communicate effectively and professionally with members and providers.
Technical Skills/Requirements: Proficient in Microsoft Office (Word, Excel).