Customer Services Specialist
2.
3 Jackson, MI Jackson, MI Full-time Full-time $15.
88 - $18.
41 an hour $15.
88 - $18.
41 an hour Under the direction of the Supervisor, Customer Services the Customer Services Specialist position responds to questions and concerns from consumers, providers, and the community at large, and also oversees the complaint/dispute/appeals process in accordance with the Balanced Budget Act.
The Customer Services Specialist is knowledgeable about all aspects of LifeWays including access to services, benefits, eligibility, dispute resolution processes, Medicaid Fair Hearings process, and protocols.
This position serves as an important link between LifeWays' internal and external customers.
Essential Functions:
Assists people with and oversee the processes for local complaints, grievances, appeals, and accessing local dispute resolution services in accordance with LifeWays policies and procedures.
Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to appropriate staff for review.
Acts as a member advocate; clearly communicating the appeal and grievance process and procedures both orally and in writing.
Analyzes and interprets systems data, contract language, regulatory provisions, and apply to casework.
Provides information about how to access the various rights processes.
Tracks, reports, and analyzes patterns of problem areas for the organization.
Provides data as needed, but at least quarterly, for required Michigan Department of Health and Human Services (MDHHS) and Mid-State Health Network (MSHN) reporting.
Orients individuals to services and benefits available through LifeWays and the provider network.
Provides information about how to access behavioral health, primary health, and other community services.
Provides coordination as the LifeWays Fair Hearing Officer in accordance with LifeWays policies and procedure.
Answer phone, direct calls, and provides accurate information to callers.
Maintain interpreter/translation database; coordinates with contracted interpreting providers to meet consumer needs; reviews interpreting service invoices for accuracy.
Organizes and facilitates the LifeWays Consumer Advisory Council (CAC).
Serves as the LifeWays liaison to the Mid-State Health Network (MSHN) Consumer Advisory Council (CAC).
Manages meeting room requests from external organizations.
Provides support to the Medical Records Specialist, as needed.
Maintains regular and predictable attendance.
All other duties as assigned.
Required Education/Certification/Licensure:
Associates degree in related field or equivalent experience.
Preferred Education/Certification/Licensure:
Bachelor's degree in related field.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
3 Jackson, MI Jackson, MI Full-time Full-time $15.
88 - $18.
41 an hour $15.
88 - $18.
41 an hour Under the direction of the Supervisor, Customer Services the Customer Services Specialist position responds to questions and concerns from consumers, providers, and the community at large, and also oversees the complaint/dispute/appeals process in accordance with the Balanced Budget Act.
The Customer Services Specialist is knowledgeable about all aspects of LifeWays including access to services, benefits, eligibility, dispute resolution processes, Medicaid Fair Hearings process, and protocols.
This position serves as an important link between LifeWays' internal and external customers.
Essential Functions:
Assists people with and oversee the processes for local complaints, grievances, appeals, and accessing local dispute resolution services in accordance with LifeWays policies and procedures.
Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to appropriate staff for review.
Acts as a member advocate; clearly communicating the appeal and grievance process and procedures both orally and in writing.
Analyzes and interprets systems data, contract language, regulatory provisions, and apply to casework.
Provides information about how to access the various rights processes.
Tracks, reports, and analyzes patterns of problem areas for the organization.
Provides data as needed, but at least quarterly, for required Michigan Department of Health and Human Services (MDHHS) and Mid-State Health Network (MSHN) reporting.
Orients individuals to services and benefits available through LifeWays and the provider network.
Provides information about how to access behavioral health, primary health, and other community services.
Provides coordination as the LifeWays Fair Hearing Officer in accordance with LifeWays policies and procedure.
Answer phone, direct calls, and provides accurate information to callers.
Maintain interpreter/translation database; coordinates with contracted interpreting providers to meet consumer needs; reviews interpreting service invoices for accuracy.
Organizes and facilitates the LifeWays Consumer Advisory Council (CAC).
Serves as the LifeWays liaison to the Mid-State Health Network (MSHN) Consumer Advisory Council (CAC).
Manages meeting room requests from external organizations.
Provides support to the Medical Records Specialist, as needed.
Maintains regular and predictable attendance.
All other duties as assigned.
Required Education/Certification/Licensure:
Associates degree in related field or equivalent experience.
Preferred Education/Certification/Licensure:
Bachelor's degree in related field.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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