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The incumbent functions as a representative of Hometown Health to provide appropriate responses to its customers and consumers regarding Plan benefits to include, but not limited to eligibility, provider network, referral and authorization process, claims payment, as well as policies and procedures. This will be done in a consistently service-oriented manner to provide the highest level of satisfaction.
The incumbent also functions as a representative of the Renown Medical Group. Per local, statewide or nationally determined protocol and physician peer-reviewed recommendations, or in compliance with those initiatives or regulations, the incumbent will have the following responsibilities:
* Identify the unique health care needs of individuals in targeted cohorts
* Assists customers in utilizing resources, including scheduling appointments and assisting with completion of applications for programs for which they may be eligible
* Advises customers on issues related to diagnostic/preventive screenings, such as breast cancer screening, pap smears, colorectal, or diabetes screenings. Also, advises on issues related to improving general health in regards to nutrition, physical activity and/or tobacco cessation, as well as referring on issues related to mental health, substance abuse
* Performs chart review and assessment of care gaps or opportunities, and effectively communicates care gaps to customers and/or care team members
* Assists with communicating plans and goals set by the care team, and assists with disease prevention and management, social determinants, and issues related to self-care
* Assists customers in creating a healthy vision and goals for their health & wellness program. Refer to nurses, social workers and pharmacists as indicated by patients' needs
Knowledge, Skills & Abilities:
* Ability to exercise appropriate response procedures on inquiries, complaints and e-mails needing review and additional follow up prior to providing responses
* Communicates well with customers in person, by phone, or in writing, including the ability to deliver effective telephonic and in person coaching in a manner that promotes positive behavior change
* Ability to adapt various coaching and education methods to accommodate the unique physical, psychosocial, cultural, age-specific needs of each customer served
* Superior customer service behaviors and standards
* Demonstrated professionalism and diplomacy with interacting with customers of all ages, their families, physicians, physician office staff and other health care providers in the accurate collecting of demographic, clinical and financial information in person or via telephone interviews
* Keeps abreast of community resources to assist patients with social determinants of health, such as transportation, food, housing and obtaining necessary medications
* Knowledge of health care processes and procedures
This position does not provide patient care.
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