Contact Center Specialist

Summary: 

The Contact Center Specialist is responsible to receive, triaging, process, and/or investigating, as necessary, all inbound phone/emails inquiries. The role will ensure that they resolve requests in a timely and efficient way while in compliance with the relevant policies & procedures. The contact center specialist will be expected to develop and maintain in strict confidence its findings from case investigations related to highly sensitive & confidential issues reported by callers.

RESPONSIBILITIES:

–      Manage all call requests/issues received via phone calls / Emails from Outlook and care compass requests from Interdisciplinary Team (IDT) and/or vendors etc., related to (but not limited to) PACE program general services, transportation, DME orders, home health aide (HHA), personal care aid (PCA), CDPAS scheduling/coordination, PERS, claims, grievances, appeals, the status of prior requests/issues reported, etc.

–      Complete assessment and coordination notes for all transactions into the EMR database with documentation reflecting the context of the call (examples: service plans, authorizations, encounters, coordination notes, grievances, call assessments, demographic updates, etc.) in designated systems.

–      Outreach to inquiring callers to keep them informed about their issues/request’s status or resolution.

–      Complete Quality validation calls and Capture and modify any demographic missing by the PACE staff who submitted the original request, and communicate to all parties key updates to ensure that deliverables are achieved for the participant

–      Assist the supervisor with a variety of administrative tasks, including but not limited to, providing training to staff, managing, and handling escalated calls as needed.

–      Actively track outstanding caseload and prioritize escalated issues, disputes, and replacement requests as assigned on the worklist.

–      Adhere to HIPAA policies when working with confidential information, such as patient services and data summaries, and quality assurance reports, and use any/all sources of information (ie. Staff documentation errors, missing information in Care Compass, validation calls, grievances, etc.).

–      Provides general administrative oversight support as needed.

–      Maintains departmental quality and productivity goals.

–      Adhere to company and department policies and procedures.

–      Adheres to all applicable compliance requirements and the Code of Conduct.

 Requirements:

–      Able to type at least 45 WPM.

–      Bilingual Requirement: Spanish, Russian, or Chinese

–      1 – 2 years experience in customer service, quality, and/or auditing experience.

–      Excellent written and verbal communication skills.

–      Ability to thrive in a fast-paced environment and meet assigned deadlines.

–      Excellent organizational skills, accuracy, and attention to detail.

–      Ability to operate both independently and collaboratively as required.

–      Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.