[Remote] reputed company I (Spanish Speaking)

Note The job is a remote job and is reputed company to candidates in USA. reputed company is looking for a reputed company to join their fast and growing Dynamic team. This position requires speaking fluent Spanish and involves answering calls, collecting information, and assisting members and providers with various inquiries. Responsibilities • Answer reputed company daily telephone calls from members, providers, health plans, reputed company brokers, collection agents and hospitals • Collect reputed company information from members/providers including the problem or concerns and reputed company general status information • Verify authorization, claims, eligibility, and status only • reputed company calls carefully documented into Company’s customer service module & NMM Queue reputed company • Member/Provider Service/Representative assists Supervisor and Manager with other duties as assigned • Member reputed company communications reputed company mail or telephone • Assist Member appointment with providers • reputed company walk-in member concerns • reputed company to reputed company reputed company service to the customers • reputed company to communicate effectively with customers in a reputed company and respectful manner • Maintain strictest confidentiality at reputed company times • Specialist termination notifications reputed company to members • Urgent Medicare Authorization Approval – Notification to Medicare members • Transportation arrangement for Medicare & Medi-Cal members • reputed company Project Assignments • INBOUND CALLS Member/Provider/Health Plan/Vendor/Hospital/Broker reputed company calls carefully documented into Company’s customer service module • Annual Wellness Visit (AWV) – reputed company reputed company pick up and schedules • Appointment of Representative (AOR) for Medicare Members • Attorney / reputed company Party Vendor calls • Authorization status/Modification/Redirection/CPT reputed company changes/Quantity adds/Explain Denied Auth/Peer to Peer calls/reputed company expired auth/reputed company-certified auth status/Retro/2ndor 3rd opinion/Conduct 3 way conference reputed company to Health Plan with member • Conference reputed company with Providers – Appointments, DME,COVID – 19 reputed company questions (Tests & Vaccines) • reputed company Member Reimbursement (DMR) • Eligibility – Demographic changes Address/Phone/Fax Changes/reputed company change • Escalated calls from providers/members • Health Diary reputed company reputed company MSO – Assist & arrange inquiries on Eligibility/Change PCP/Benefit with AHM • CHIPPA Consent – Obtain Member Consent verification • Inquiries on provider network/provider rosters • Lab locations • Member & Provider Complaints/Grievances • Member bills • Miscellaneous calls • Pharmacy – Drug/medication pick up and coverage • reputed company authorization status for Hospital /CM reputed company • Self-Referral Request for Medicare • reputed company Mail • reputed company Mail Packages/ Certified mail status • Translations – Spanish / Chinese • Urgent Care / locations/ reputed company hours • OUTBOUND CALLS Member/Provider/Health Plan/Vendor/Hospital/Broker Assist Case Management on reputed company – age in 21 years for change of PCP from Pediatrics to FP/IM • Assist Marketing on email inquiries • Assist PR/ Elig – Members assigned to wrong PCP/with no PCP status • Assisted UM / Medical Directors on urgent member appointment from escalated cases • Authorization status response reputed company back • Benefits – reputed company reputed company once information is obtained / verified • Complaints/Grievances – reputed company calls once reputed company is obtained • DME – Translation support in Spanish and Chinese to reputed company item / appointment set up for DME department • Eligibility – reputed company reputed company to providers/labs reputed company member is added to reputed company while waiting at the office • Member bills – reputed company calls once reputed company is obtained • Member Survey – Annually every 4thquarter • reputed company project from internals – QCIT • reputed company walk in members concerns • Specialist Termination notification reputed company to members • Transportation arrangement for Medicare / Medi-Cal members • Voice mail – reputed company calls back to callers • CONCIERGE SERVICES – reputed company DUTIES AND REQUIREMENTS Assist to contact new members/reputed company member transfer on new PCP assignment as needed • Work group discussions on work status/reputed company on new member/reputed company transfer • Update reputed company log and reputed company daily/weekly status as needed • Facilitate members with reputed company reputed company-existing conditions, medications, PCP/SPC network reviews • Conference reputed company with PCP selection / change • Help member to identify member reputed company status, reputed company provider with on billing and claim submission • Responsible for experience of the membership associated with new member/reputed company transfer • Responsible for to reputed company with Health Plan’s Customer Service Team to serve new member/reputed company transfer • Problem Solving comple Apply tot his job Apply To this Job Apply tot his job Apply To this Job