CTM Coordinator - Remote

    • Tampa, FL

RESPONSIBILITIES:
Kforce has a client in search of a CTM Coordinator in Tampa, Florida (FL). This role is currently 100% remote and will switch back to office environment when COVID-19 ramps down. Summary: The candidate responds to member, provider, CMS, SPAP and SHIP inquiries received via phone, CTM (Complaint Tracking Module) and email regarding PDP, CCP and Medicaid lines of business, including Claims, CIU, Enrollment, Pharmacy, Billing, Case Management, and Appeals in a professional, timely, accurate and caring manner while consistently meeting all CMS guidelines and requirements. Instrumental in providing suggestions to reduce complaints and increase Star Ratings. Key Duties and Responsibilities:

  • Responds to member, provider, CMS, SPAP and SHIP inquiries via telephone, CTM (Complaint Tracking Module) and email, while meeting all corporate, regulatory and CMS guidelines and performance standards; Independently evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare & Medicaid Services (CMS) guidelines, and internal policies, procedures, and standards that are alleged to have been violated
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified; Assist in the education of new members and in the re-education of existing members regarding health plan procedures
  • Records, investigates and resolves complaints as detailed in the CMS Standard Operating Procedures (SOP) and the CTM Policies and Procedures
  • Investigates problems of an unusual nature in the area of responsibility; Presents proposed solutions in a clear and concise manner
  • Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks


REQUIREMENTS:
  • A High School diploma or GED Required
  • An Associate's degree in a related field Preferred
  • A Bachelor's degree in a related field Preferred
  • 1+ years of experience in Contact Center and/or Customer Service Environment Required
  • 1+ years of experience in Experience within a Healthcare company Preferred
  • 1+ years of experience in CTM or Escalations Experience Preferred
  • Demonstrated written communication skills Advanced
  • Demonstrated interpersonal/verbal communication skills Advanced
  • Ability to multitask Intermediate
  • Demonstrated organizational skills Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Ability to effectively present information and respond to questions from families, members, and providers Intermediate
  • Demonstrated analytical skills Intermediate
  • Ability to work with people from diverse backgrounds Intermediate
  • Ability to act on feedback provided by showing ownership of their own development Intermediate
  • Ability to define problems collects data, establish facts and draw valid conclusions Intermediate
  • Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication Intermediate
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

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