Member Services Supervisor / Job Req 671415436

PRINCIPAL RESPONSIBILITIES:

Under general direction from the Sr. Director, Member Services, the Member Services Supervisor is responsible for the day-to-day supervision of Member Services Representatives, collaborating with other department Supervisors and other department leadership members to meet and exceed performance targets. The Member Service Supervisor will primarily oversee Member Services Representative Tier I and Member Services Representative Tier II.

The Member Service Supervisor is responsible for ensuring member concerns are processed in a timely and accurate manner by communicating and enforcing department goals and objectives within a total quality management approach and compliance with all applicable state/federal regulations. The Member Services Supervisor will be responsible for the quality of the member services representatives' daily work and activities, including but not limited to monitoring, developing, implementing, and evaluating the departmental call center operations to ensure optimal proficiency and effectiveness. The Supervisor will oversee assigned production and workflow systems, monitor, and enforce production and quality standards, ensure compliance with all operating policies and procedures, and collaborate with other departments to ensure the Alliance's business, operating, and reporting goals are met. The Supervisor may occasionally function as a Member Service Representative in high call volumes or staffing shortages.

PRINCIPAL RESPONSIBILITIES INCLUDE:

• Supervise the daily operations of Call Center staff to ensure appropriate usage of resources to facilitate the Call Center process.
• Identifying the training needs includes assisting in the development of programs, training materials, job aids, orientation checklists, and competency checklists necessary to meet the educational and training needs of departmental staff.
• Develop tools and workflows to assist in the training and development of staff
• Responsible for maintaining any training materials to align with the current process to provide accurate and consistent plan benefit and service information to our members to meet regulatory requirements.
• Develop and conduct team training and education courses, including management education and training for new employees, ongoing staff, and cross-training of staff as needed.
• Develop and maintain complex audit processes and audit tools related to grievances, quality, compliance, and accurate data entry.
• Train staff to use of audit tools and identify patterns or trends that require additional training or corrective action.
• Educate staff as necessary to ensure consistent performance and adherence to standards
• Audit staff in accordance with established auditing processes, work with the team to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management.
• Coach and train staff to identify the potential quality of care/service and accessibility concerns and refer to Grievance and Appeals (G&A), Case and Disease Management (CM/DM), Behavioral Health/ABA or Quality Improvement (QI).
• Identify opportunities for process improvements to facilitate department functions and ensure compliance with applicable governmental program guidelines.
• Provide leadership while serving as a subject matter expert for Member Services and acts as a resource for AAH and community partners.
• Identify system issues that fail to provide appropriate service to members or meet service expectations and make recommendations for improvement.
• Evaluate policies and procedures and analyze/recommend enhancements to ensure adherence to regulatory requirements.
• Assist with ensuring consistent data collection from MS staff that is used to assist the company in achieving strategic goals, to improve monitoring and reporting in order to meet external requirements.
• Assist in writing and implementing business requirements for any software systems used by the call center to assist external and internal customers including but not limited to Healthsuite; QualitySuite; CiscoFinesse; TruCare; PerformPA; RxNova; Darwin, Calabrio; Hanna/Cyracom-InterpreterServices appointment Scheduler; delegate portals, etc.
• Maintain and report records of training activities and employee monthly performance progress reports to MS Leadership.
• Assist with revisions to Policy and Procedure and work process development.

• Work closely with all levels of call center leadership regarding daily operations.
• Manage and prioritize workload while meeting deliverables and expectations.
• Maintain working knowledge of regulatory requirements for DHCS, DMHC and NCQA and apply to daily work, adhering to department workflows.
• Assist leadership with external regulatory audits including DHCS, DHMC and NCQA: data gathering, file assembly and bookmarking.
• Respond to members and interdepartmental staff (clinical and non-clinical, including Legal/Compliance, G&A, CM/DM, BH) inquiries at any given time in a professional and timely manner to help resolve member issues.
• Responds to inbound calls, emails, chat, member portal requests and initiates outbound calls to resolve complex issues, including member dissatisfactions that require additional research.
• Identify, analyze, and advise management on work-flow issues, performance trends and provide recommended solutions. Address performance improvement issues as needed and in accordance with the department policies and procedures. Facilitate communication and care coordination between inter-departments (Case Management or Behavioral Health).
• Serve as initial point of contact for operational questions and issues related to members both internally and externally; coordinate with Behavioral Health, Case Management and other departments to implement solutions.
• Demonstrate a comprehensive understanding of coverage and benefits in order to promote appropriate service utilization for DHCS, DMHC and NCQA
• Research complex issues and bring to resolution.
• Assist leadership during and following onboarding of new hires to serve as a resource for ongoing support to support successful integration into the team.
• Assist MS Leadership with preparation of files for Health Plan audits for DHCS, DMHC, and NCQA.
• Accurately interpret and communicate member benefits and serve as resource for internal departments and the IT Department in verifying and resolving member eligibility/other health coverage (OHI).
• Respond to provider, member, and staff inquiries at any given time in a professional and timely manner.
• Meet annual performance goals established for the position.

• Prepare for and participate in regulatory audits and develop and monitor corrective actions plans.
• Complete other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB:

• Supervise, audit, monitor, and train of staff.
• Proficient in 12+ platforms/applications used by call center staff to educate, research and resolve member issues/concerns.

• Promote a positive member experience, acts as an innovative problem solver, and helps the team arrive at long-term solutions to meet the needs of our members.
• Embrace accountability, strong work ethics, and integrity.

• Writing, reporting, administration, and analysis.
• Communicate effectively and efficiently internally and externally.
• Develop long and short-range strategic plans for member services activities.
• Make verbal presentations.
• Act as a resource to staff in daily coaching and problem-solving.
• Lead and participate in internal and external committees and meetings.
• Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
• Perform all the functions of an MSR in times of high call volumes or staff shortage.

• Coordinate the activities of professional and technical staff with other supervisors for caseload (EG) management and meeting timelines; interacts with staff to resolve issues; provides coverage as needed.
• Recruit, hire, and perform retention analysis and resolution.
• Call center systems monitoring, user acceptance testing (UAT), and maintenance.
• Handle escalated calls.

• Measure and improve customer satisfaction levels.

• Oversee processes for serving members who request assistance in person (walk-ins).
• Other duties as assigned.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using multiple monitors, keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of files, binders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.

Number of Employees Supervised: 15-20

Number of Direct reports: 6-8

MINIMUM QUALIFICATIONS:

• Bachelor's degree required or combination of education and equivalent
• High School Diploma or GED required

• Two to three years healthcare related experience preferred.
• Two years' experience in a Supervisor, Trainer, Quality Assurance or Auditor role highly preferred

Internal Applicants:

• Two years' experience as an MSR III (maintaining 95% or higher department performance metrics for 12 consecutive months; with above or outstanding annual performance evaluation average rating) required.

• Experience working with Medi-Cal Managed Care Plans (MCPs) Medicare, and health services experience preferred.
• Bilingual in English and in one of AAH's defined threshold language (Cantonese, Spanish, Vietnamese, Tagalog & Arabic) is preferred.
• Current driver's license, automobile insurance, and car registration required.
• Working knowledge of contact center phone systems and customer management/auditing applications (Cisco Finesse, CUIC, UCCX, Calabrio, RAM-Healthsuite) a plus
• Ability to motivate, train (provide instruction to help team members learn a skill, process or procedure), and supervise.
• Ability to make thoughtful decisions and exercise sound judgment.
• Ability to work effectively in a multidisciplinary approach in management.
• Ability to work within guidelines and protocols to achieve decisions independently.
• Excellent leadership, organizational, verbal, and written communication skills, and problem-solving skills.
• Ability to coach and mentor team members to improve their performance, maintain compliance with policies and procedures or advance their careers (Tier II and Tier III).
• Excellent customer service skills.
• A "hands-on" leader.
• Ability to develop, monitor and adjust production standards.
• Well organized and detail oriented.
• Ability to handle multiple projects and balance competing priorities.
• Working knowledge of managed care.
• Ability to act as resource to department staff.
• Knowledge of DME and Home Health Services.
• Knowledge of ancillary and hospital-based services.
• Knowledge of CalAIM waiver and initiatives.
• Proficient experience in Windows including current Microsoft Office suite.
• Experience working with and monitoring ACD systems.

SALARY RANGE $92,051.06 - $138,076.59 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.