Bilingual

• Communicate and provide education to members and providers on insurance plan benefits and digital health solutions.
• Use negotiation and motivational interviewing techniques to increase engagement.
• Pro-active and reactive support for members, including outbound phone/email/text outreach.
• Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement.
• Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls.
• Accurately track and document work on a variety of internal software tools and platforms.
• Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers.
• Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
• Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals.
• Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.

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