Customer Service HRS Specialist

CareOregon is a healthcare organization seeking a Customer Service HRS Specialist to serve as the initial point of contact for members and providers. The role involves providing advanced customer service and support for inquiries related to Health-Related Services, ensuring effective communication and resolution of issues.

Responsibilities:

• Respond to inquiries originating from a wide range of customer groups including members, providers and other departments and organizations (e.g., community-based organizations, regulatory bodies such as the Oregon Health Authority, etc.)
• Communicate with customer groups via telephone, email and text as appropriate
• Research, verify and resolve a broad array of inquiries, both simple and complex, related to Health-Related Services
• Assist members with applying for Health-Related Services and obtaining information about the status of their requests
• Provide clear communications, timely responses and high-level customer service
• Use online tracking systems to document all activities and communications related to each Health-Related Services inquiry, request, status and outcome
• Receive and apply updates on current, evolving policy and process changes related to Health-Related Services
• Perform ongoing analyses of data and information to identify opportunities for improvement in operational efficiencies
• Collaborate with teams inside and outside of the department to share information, obtain information and resolve customer inquiries
• Partner closely with the Authorization team to gather and compile complete and accurate information for requests and coordinate any necessary outreach
• Complete (off phone) administrative tasks and project work in an efficient and timely manner
• Adhere to all Health Insurance Portability and Accountability Act (HIPAA) requirements and organizational standards related to protected health information, privacy and confidentiality
• Create and update job aids, reference information and other documentation as needed
• Participate in cross-departmental workgroups as needed

Requirements:

• Minimum 3 years' customer service experience including 2 years supporting healthcare members, providers or health-related insurance providers, vendors or related entities
• Minimum 1 year experience in Call Center
• Knowledge of or ability to quickly learn Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to medical health, Medicaid and Medicare Industry
• Knowledge of the basic concepts of Managed Care
• Knowledge of principles of organizational change and ability to act as a change agent
• Knowledge of Health-Related Services (HRS) requirements and processes
• Ability to learn and apply Oregon Administrative Rules (OARs), Federal Laws and various agency regulations as they relate to processing Health Related Services
• Ability to effectively use phone system and system reports
• Strong computer and data analysis skills
• Excellent interpersonal skills, customer service and strong active listening skills
• Excellent reading, spoken and written communication skills
• Ability to proactively work to build and improve team operations
• Ability to work under pressure in a complex and rapidly changing environment
• Basic mathematical skills
• Excellent problem solving and decision-making skills
• Ability to successfully manage multiple tasks
• Ability to support and comply with organizational policies, procedures, and guidelines
• Ability to participate fully and constructively in department meetings and contribute to decisions
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day
• Customer service experience with a health insurance carrier/health plan, the Oregon Health Plan and/or roles providing crisis management