Lnea de Acceso - Call Center (Turnos Rotativos)

Job Title

Serve as the initial point of contact for incoming calls to the center, screen telephone calls, and assess the severity/acuity of each call in order to appropriately evaluate and route it.

Essential Functions:

• Always demonstrate a positive, empathetic, and professional attitude toward customers. When patient needs are not met, acknowledge concerns and work toward resolving complaints. Recognize that patient safety is a top priority.
• Provide information and services related to coverage determination, service authorization (or denial), and linkage to resources, services, and support systems.
• Answer all telephone calls using the approved telephone answering script.
• Assess each call for a potential crisis before placing any caller on hold.
• Identify and refer callers to appropriate community resources.
• Observe and adhere to all HIPAA and Recipient Rights policies and procedures.
• Provide consumer-focused, professional, and compassionate service.
• Document incoming telephone calls and collect demographic information for all callers before making referrals or transfers.
• Perform warm transfers for individuals requiring a clinical assessment/screening to the center's clinicians.
• Ensure that all aspects of the enrollment and re-enrollment processes are completed. This includes answering inquiries, verifying consumer residency, and assigning clients as needed.
• Provide consumers with accurate information regarding grievances, appeals, and local dispute resolution processes associated with their specific benefit plan.
• Conduct follow-up calls and customer satisfaction calls.

Other Functions:

• Perform other functions and tasks as assigned.

Education/Experience/Skill Requirements:

• Ideally, possess college credits or a completed degree in Psychology or Social Work.
• Availability to work rotating shifts.
• Excellent communication and interpersonal skills.