Regulatory Relations Specialist jobs in Erie, PA

Regulatory Relations Specialist files applications and interacts with governmental officials during the regulation and certification process for a plant or other facility. Assists in developing procedures to ensure regulatory compliance. Being a Regulatory Relations Specialist gathers data pertaining to organizational projects and their impact on the regulation process. May require a bachelor's degree. Additionally, Regulatory Relations Specialist typically reports to a supervisor or manager. To be a Regulatory Relations Specialist typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)

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Member Relations Representative - Bilingual
  • Health Partner Plans, Inc.
  • Erie, PA FULL_TIME
  • Why Choose Jefferson Health Plans?
    We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
    We offer Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Jefferson Health Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.
    While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.
    Perks of Jefferson Health Plans and why you will love it here:
    • Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
    • Flextime and Work-at-Home Options
    • Benefits & Wellness Program including generous Time Off
    • Impact on the communities we service.
    We are seeking a talented and enthusiastic Member Relations Representative - Bilingual to join our team!
    The Medicare Member Relations Representative (Tier 1) promotes a positive image of Jefferson Health Plans via telephone, utilizing each contact as an opportunity to educate members and providers about the plan, effectively handling inbound, outbound and outreach calls to and from members, providers, and other areas internal and external to Jefferson Health Plans. This role requires a basic understanding of the concepts of Medicaid, Medicare and CHIP lines of business and demonstrating skills in assisting the members/providers with the reason for the call as outlined in the primary responsibilities or escalating the call as appropriate to the Tier II level of agents. Ensure member retention as well as advise them of specific eligibility requirements to assure continued customer satisfaction.
    As the Member Relations Representative - Bilingual your daily duties may include:
    • Educate members and providers about Jefferson Health Plan with the intent of retaining members and providing a high level of customer service.
    • Respond to member and member-related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
    • Answer eligibility and benefits questions, assuring that members receive service, use the plan correctly and gain a high level of satisfaction with the plan.
    • Assist members with demographic changes, updates or as required coordinating the changes with the County Assistance Office, CMS, Office of CHIP or the Department of Health and Human Services.
    • Assist members and providers with registering on the member/provider portal and basic self service functions.
    • Assist with requests for ID cards, Welcome Kits, member handbook, provider directory or any other printed material that can be mailed out.
    • Assist with PCP changes and scheduling initial doctor appointments.
    • Collaborate or escalate with internal departments to facilitate resolutions to member’s issues and concerns.
    • Conduct targeted telephonic outreach to members using a prepared script depending on Manager’s direction.
    • Open or build new cases in the care management system and route to the appropriate staff following the direction of the Team Leader, Supervisor or Manager.
    • Research members’ demographics in regulatory system and build cases in Member Relations documentation system by calling hospitals, PCP offices, and/or home care agencies to locate a member’s most recent phone number.
    • Schedule and coordinate transportation need.
    • Utilize the Member Relations translation vendor as indicated by the needs of the member.
    • Refer members to the appropriate Nurse Advice lines and appropriate programs.
    • Maintain accurate data entry into designated software systems.
    • Promote partnership with Quality Management (QM), Utilization Management (UM), Care Coordination, Healthcare Economics and Special Needs Unit (SNU).
    • Maintain call records, logs and other documentation in accordance with departmental requirements.
    • Escalate trends and issues which impact the membership for immediate resolution.
    • Operate all applications and telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange.
    • Participate in appropriate staff meetings and training sessions, reporting on trends and issues which impact members and Jefferson Health Plans as a whole.
    • Attend monthly meetings as scheduled.
    • Adhere to daily schedule, responding to emails timely, use of appropriate call center status, confidentiality of information, and general business protocols.
    • Perform other clerical and support tasks as assigned.
    • Other duties as assigned.
    Qualifications
    • High School Diploma or or 3 years of Equivalent work experience required.
    • Excellent communication and interpersonal skills required.
    • Minimum of 1 years of call center experience, inbound/outbound telephone experience or equivalent face to face customer service experience preferred.
    • Healthcare experience is preferred. Managed care experience is a plus.
    • Bilingual Required
    Skills, We Value:
    • Excellent written and verbal communications skills.
    • Bilingual a plus
    • Basic typing and computer skills required. Experience using Microsoft Word and Excel is desirable.
    • Ability to work independent of direct supervision, but also must be able to work within a Team.
  • 21 Days Ago

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Employer Relations Officer
  • Mercyhurst University
  • Erie, PA FULL_TIME
  • 501 East 38th Street Erie, PA 16546 814-824-2000 800-825-1926 mercyhurst.edu Employer Relations Officer Location: Erie Department: Advancement Reports To: Director of Career Development Full/Part Time...
  • 1 Day Ago

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Member Relations Compliance Rep
  • Health Partner Plans, Inc.
  • Erie, PA FULL_TIME
  • Why Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that includ...
  • 17 Days Ago

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Assistant Director of Athletics for External Relations
  • gannon
  • Erie, PA FULL_TIME
  • Will coordinate revenue generation and assist in the day-to-day operation of the Athletics Department, including, but not limited to, alumni engagement, special events, team fundraising initiatives, c...
  • 14 Days Ago

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Customer Relations Representative - State Farm Agent Team Member (Customer Relations Focus)
  • Aaron Bussard - State Farm Agent
  • Conneaut, PA PART_TIME
  • Position Overview Looking for a part-time job that provides meaningful work and competitive compensation? Consider a position in a State Farm Agent's office. Responsibilities Work with the agent to es...
  • 1 Day Ago

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Customer Relations Representative - State Farm Agent Team Member (Customer Relations Focus)
  • Brandon Fresch - State Farm Agent
  • Erie, PA FULL_TIME
  • Position Overview State Farm Insurance Agent located in Erie, PA is seeking an outgoing, career-oriented professional to join their team. As a State Farm team member for Brandon Fresch - State Farm Ag...
  • 11 Days Ago

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0 Regulatory Relations Specialist jobs found in Erie, PA area

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Hospice Registered Nurse- Home Health (Erie County)
  • University of Pittsburgh Medical Center
  • Erie, PA
  • UPMC Home Health is hiring a Hospice Registered Nurse to join its team in Erie! This is a Full-Time position working mai...
  • 3/29/2024 12:00:00 AM

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Sr. Environmental Program Manager (Hybrid)
  • Latitude, Inc.
  • Erie, PA
  • Details: Salary: $130,000 - 160,000/year This position allows for 2-3 days per week remote / work from home. MAJOR RESPO...
  • 3/28/2024 12:00:00 AM

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Travel Nurse RN - Med Surg - $2,035 per week
  • Adventist Health
  • Erie, PA
  • Vibra Travels is seeking a travel nurse RN Med Surg for a travel nursing job in Erie, Pennsylvania. Job Description & Re...
  • 3/28/2024 12:00:00 AM

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Travel Nurse RN - Long Term Acute Care - $2,035 per week
  • Adventist Health
  • Erie, PA
  • Vibra Travels is seeking a travel nurse RN Long Term Acute Care for a travel nursing job in Erie, Pennsylvania. Job Desc...
  • 3/28/2024 12:00:00 AM

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Travel Nurse RN - PCU - Progressive Care Unit - $2,035 per week
  • Adventist Health
  • Erie, PA
  • Vibra Travels is seeking a travel nurse RN PCU - Progressive Care Unit for a travel nursing job in Erie, Pennsylvania. J...
  • 3/28/2024 12:00:00 AM

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Travel Nurse RN - Med Surg / Telemetry - $2,035 per week
  • Adventist Health
  • Erie, PA
  • Vibra Travels is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Erie, Pennsylvania. Job Desc...
  • 3/28/2024 12:00:00 AM

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Physician Assistant, Millcreek Family Practice
  • Highmark Inc.
  • Erie, PA
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job provides primary health care and perform...
  • 3/28/2024 12:00:00 AM

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Nurse Practitioner, Pre-admission testing (part time)
  • Highmark Inc.
  • Erie, PA
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job provides primary or acute healthcare ser...
  • 3/28/2024 12:00:00 AM

Erie (/ˈɪəri/; EER-ee) is a city on the south shore of Lake Erie and the county seat of Erie County, Pennsylvania, United States. Named for the lake and the Native American Erie people who lived in the area until the mid-17th century, Erie is the fourth-largest city in Pennsylvania, as well as the largest city in Northwestern Pennsylvania, with a population of 101,786 at the 2010 census. The estimated population in 2017 had decreased to 97,369. The Erie metropolitan area, equivalent to all of Erie County, consists of 276,207 residents. The Erie-Meadville, PA Combined Statistical Area has a pop...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Regulatory Relations Specialist jobs
$68,566 to $94,129
Erie, Pennsylvania area prices
were up 1.5% from a year ago

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