Care Advocate Specialist
Carenet - San Antonio, TX

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Care Advocate Specialist

Carenet has a challenging opportunity for a Care Advocate Specialist. Reporting to the Client Services Department, this position is responsible for managing and coordinating a high volume of service requests from members and providers. This is a non-clinical position. The Care Advocate Specialists are not responsible for conducting any triage program activities that require interpretation of clinical information.

Required Skills, Knowledge and Abilities:

Provide exceptional customer service via telephone

Ensures customer satisfaction by providing quality service, identifying customer needs and assisting them with issues/concerns related to health care issues

Research, identify and problem solve, verify eligibility of service and place call backs as required

Meet and support established service goals and business objectives by meeting and exceeding performance standards

Adapts communication style to persons representing diverse personal, professional, cultural, and socio-economic backgrounds.

Ability to multi-task; simultaneously thinks, talks, and types.

Uses excellent hearing and listening skills to receive detailed information

Responds to the needs of a 24/7/365 operation

Contact health plans on member’s behalf to coordinate care

Collaborate care for members with complex medical issues

Facilitate the collection and transfer of medical records as needed

Arrange health care services for members

Locate various healthcare resources in member’s community

Ability to analyze and understand multiple health plan benefits

Proactively identify and make appropriate referrals into the member’s healthcare program

Continuously evaluates process and programs to ensure Client, Accredited and Carenet standards of practice are met and implements methods are recommendations to improve process.

High Level Job Qualifications are as follows:

Education/Experience: High School Diploma or General Education Degree (GED) required; some college preferred. Minimum of three years medical clerical experience required. Minimum of two years customer service, medical office/clinic or institutional setting; or equivalent combination of education and experience required. Healthcare experience required. Medicare/Medicaid experience preferred. Medical benefit and insurance coordination experience preferred.

Language Ability: Ability to read, analyze, and interpret company software, guidelines, health references, professional journals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions.

Math Ability: Ability to calculate figures and amounts. Ability to apply concepts of basic algebra.

Reasoning Ability: Ability to deal with and solve problems using solid judgment.

Technical skills: Solid PC and keyboarding skills required. Ability to handle multiple line phone systems, pagers and paging systems preferred. Must be proficient in Microsoft Office programs including but not limited to Excel, PowerPoint and Word.

Working Conditions: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, you must be able to sit for extended periods of time and communicate with callers through the use of a headset.

You must be able to lift up to 10 pounds, have close vision, color vision, depth perception, and ability to adjust your focus with good hand-eye coordination.

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