Bilingual Non-Emergency Transportation (NET) Customer Service Rep

SCOPE OF POSITION :

Responsible for primary and/or secondary support of Arkansas Medicaid Non-Emergency Transportation (NET) Helpline and/or Extension of Transportation Services (EOTS) lines utilizing research and investigative approaches in order to achieve complex complaint resolutions and meet contract deliverables as assigned. Collaborate with medical and other professional staff to accomplish goals within designated timeframes. Support the initiative to improve and ensure continuous improvements in the quality of research and investigative methodology. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence, Accountability, Respect and Teamwork.

ESSENTIAL JOB FUNCTIONS :

1. Maintain comprehensive knowledge of specialty area, pertinent organizations, health care environment, and organizations related to NET. Knowledge should include information regarding contract, contract deliverables, policies and procedures, resources available, current research, reports, and trends, as well as a thorough understanding of the NET Transportation Broker agreement with DMS/DHS.
2. Responsible for the daily operation of the NET Helpline and the EOTS Helpline either as the primary or secondary accountable party.
3. Responsible for the resolution of customer/beneficiary complaints/issues and requests including research, investigation, policy review, complex solution development, documentation and follow up in accordance with established policy and procedures.
4. Maintain knowledge of various information systems such as state information systems and those associated with preauthorization of non-emergency transportation services.
5. Communicate effectively with customers and/or beneficiaries. Develop and maintain collaborative relationships as necessary to meet contract deliverables of specialty area project.
6. Understand and utilize project-tracking database to document and monitor activities provided and to compile a comprehensive database of activity. Maintain accurate statistical data to meet contractual and other reporting requirements.
7. Understand and maintain knowledge regarding the use of any State data applications and policies used in accordance.
8. Maintain knowledge of regulatory guidelines as stated in the transportation Broker agreement with the state and their application to contract deliverables.
9. Track regulatory issues as stated in the Transportation Broker agreement with the state as they apply to beneficiary complaints and complaint resolution or the denial of services.
10. Assist with validation of mandatory compliance documents received through the NET Portal.
11. Coordinate the timely collection and data entry of all required documentation ensuring all internal Quality Assurance and HIPAA guidelines are followed.
12. Monitor specific items within the area of focus, provide recommendations/ feedback to external customers for quality improvement and follow through for compliance of recommendations for improvement.
13. Maintain knowledge in all other areas of Outreach Services teams to assist as needed with the overall operation of the Outreach Services department.
14. Communicate needs and requests to other team members as appropriate.
15. Ensure compliance with AFMC policy, contractual obligations, state and federal laws, regulations, and compliance documentation.
16. Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance in conjunction with AFMC’s internal quality measures.
17. Daily quotas may be added to meet contract deliverables as needed.
18. Additional duties as assigned.

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices) :

Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to lift and transport 30 pounds. Must be capable of performing the essential functions of this job, with or without reasonable accommodations.

EDUCATION :

Required High School Diploma Desirable Associate’s degree or additional education

EXPERIENCE :

Required Bilingual English / Spanish. Two (2) years of experience in health care community and research, and complex complaint resolution. Desirable Previous experience in Medicaid and/or non-emergency medical transportation.

INTERNET REQUIREMENTS :

Reliable, high-speed wireless internet service (…