The Patient Experience Outreach Coordinator is responsible for patient/member outreach for various campaigns related to improving the patient’s overall experience and administrative support for other performance improvement projects and initiatives.
Provide superior customer service to internal/external customers to ensure an exceptional customer experience.
Make outbound telephone calls to patients for various campaigns while maintaining a professional level of telephone etiquette at all times.
Conduct problem identification, problem solving and process improvement recommendations.
Verify eligibility for patients prior to outbound calls and report eligibility issues for correction when necessary.
Using appropriate subject codes, accurately and thoroughly document all patient interactions in the Customer Relations System (CRM).
Utilize strong judgement to identify if patient grievances have clinical components and should be routed to the clinical team for handling.
Educate patients on the grievance and appeal process and direct them to their assigned health plan when appropriate.
Interface with contracted health plans and other internal departments to troubleshoot concerns presented by the patients during an outbound call.
Assist in the current and ongoing assessment of provider office’s current practices and provide suggestions for streamlining the process.
Identify barriers to customer satisfaction and recommend actions to address operational challenges.
Actively participate in all departmental meetings, training sessions, and other activities.
Assist with generating reports as requested.
Maintain confidentiality of all protected health information in accordance with corporate guidelines.
Provide feedback and regular status reports on assignments to Supervisor.
Provide administrative support, including generating correspondence, organize mass mailings, and coordinate training sessions.
Perform other duties as assigned.
High School diploma required. Associates degree or Bachelor’s degree in a health related field preferred.
Minimum of 4 years’ experience in a managed care or IPA setting required.
Previous experience in a Member Services or Grievance & Appeals capacity identifying and resolving member complaints, grievances and appeals.
Knowledge of Medi-cal, Medicare, CalMedi-Connect, Affordable Care Act, and Commercial lines of business.