1. CenterPoint Human Services (REV. 7/01/2013)
MCO Draft Job Description
Title: Customer Services Representative
FLSA Status: Non-Exempt
Department: Customer Services
CPHS Mission Statement
CenterPoint Human Services is a managed care organization responsible for assuring that accessible, quality and accountable care
is available for those with mental health, intellectual and developmental disabilities and substance abuse challenges.
General Definition of Work:
The Customer Services Representative performs intermediate administrative work responding to calls from enrollees,
their family members, and other stakeholders. These calls may be requests for information about the Managed Care
Organization (MCO) and its provider network, requests for crisis services, requests for a telephonic assessment to
determine the need for clinical services, requests to schedule an appointment with a network provider, or a request to
file a grievance or appeal. This employee is responsible for initiating the documentation of the call, responding to the
call per procedure and routing the calls to the appropriate MCO staff member per procedure, e.g. when the caller needs
to be assessed for clinical services. This employee is also responsible for follow up with enrollees who fail to keep their
scheduled appointment with a network provider. Related work as apparent or assigned. Work is performed under the
moderate supervision of the Customer Services Manager. Basic tasks are performed with some independence but
higher level work is more closely supervised. Relevant work products are regularly reviewed.
Qualification Requirements:
Successful performance of this job requires the skill, ability, and willingness to complete each essential function
satisfactorily. The individual must demonstrate the ability to work with moderate supervision within the scope of assigned
job functions; to responsibly complete tasks and projects within timelines, resulting in attainment of specific outcomes;
and to provide feedback regarding areas of responsibility;. The requirements listed below are representative of the
knowledge, skill and/or ability required.
Essential Functions:
The Customer Services Representative is responsible for the following (not an inclusive list, as additional duties may be
assigned):
• Answers calls during regular business hours on the MCO’s Customer Services line and responds to the general
questions of enrollees and their families.
• Transfers any call requiring clinical intervention or interpretation to a licensed Customer Services Clinician or
licensed supervisor.
• For callers seeking services, gathers demographic information and inputs this data into the MCO’s database.
Determines nature of request and transfers caller to a Customer Services staff who can link them with an
appropriate provider; schedules the enrollee with an appropriate provider within timelines established by the
Department of Medical Assistance, the Division of Mental Health, Developmental Disabilities and Substance
Abuse Services, and by URAC. Customer Services Representative never engage in clinical activities and never
issue or deny authorization of services.
• Responds to caller’s questions about the MCO, its policies and procedures, as well as questions related to the
provider network and behavioral health services in general.
• Documents information into the MCO’s database so that the collected information is stored and can be readily
retrieved;
• Performs enrollee follow-up activities. For calls triaged as “emergent”, contacts provider two hours after
referral, to ensure enrollee was seen and intervention offered. If enrollee did not appear for assessment, alerts
licensed clinician who will attempt to contact enrollee and make appropriate intervention including engaging

2. CenterPoint Human Services (REV. 7/01/2013)
emergency services (911) if enrollee cannot be contacted. On calls triaged as “urgent” or “routine”, makes
attempts to contact all enrollees who did not keep their scheduled appointment and addresses barriers,
rescheduling the assessment or referring to a licensed clinician for further assessment if appropriate. Also, per
procedure refers to Care Coordination if appropriate.
• Receives calls from enrollees in reference to grievances and appeals. Responds to questions related to grievance
and appeal procedures. Documents the details of any concern/grievance/appeal in the MCO’s database.
Attempts to resolve concern/grievance but if unable to do so, forwards documentation to appropriate staff.
Makes caller aware of who will be following up and who will advise them of the outcome of the investigation.
• Assists referring agencies with linking enrollees to services.
• Attends staff meetings and trainings as necessary.
• Assists callers who may be eligible for Medicaid obtain information on how to apply for Medicaid.
• Performs related tasks as required.
Committees and Meetings:
• Attends staff meetings to stay informed of changes in organizational procedures as well as local, State, Federal,
and Division requirements.
Supervision Received by Employee:
• The employee will have moderate supervision by the Customer Services Manager.
Interpersonal Contact:
Interpersonal contacts are a significant factor in the employee’s effective performance of job duties. The employee must
be able to communicate effectively.
Knowledge, Skills and Abilities:
• General knowledge of available programs and providers in the MCO’s provider network.
• Knowledge of general customer service protocols.
• Ability to gather information from a wide variety of callers ranging from professionals in the community to clients
who may be experiencing distress.
• Skill in the use of personal computers, related software applications, hardware, and peripheral equipment.
• Ability to prepare adequate records and to report findings and data effectively.
• Ability to solve problems within scope of responsibility and the knowledge of when to involve a supervisor.
• Ability to communicate ideas effectively in both oral and written formats.
• Ability to establish and maintain effective working relationships with associates, enrollees, families, and the
general public.
Required Training and Education:
Associate’s degree Or High School Diploma/GED with two (2) years experience in the human services field.
Experience in customer services work in the health care field is preferred.
Additional Training Preferred:
Experience in the public mental health field is highly desired due to the complexity of the work of the organization.
Special Requirements:
Possession of a valid North Carolina driver’s license.
Working Conditions
The MCO reserves the right to call upon this employee during non-business hours as needed to meet the demands of
the position. This work is sedentary and requires little to no exertion of force; work regularly requires sitting, speaking
or hearing and using hands to finger, handle or feel, frequently requires reaching with hands and arms and occasionally
requires standing, walking and repetitive motions; work has no special vision requirements; vocal communication is
required for expressing or exchanging ideas by means of the spoken word; hearing is required to perceive information
at normal spoken word levels; work requires preparing and analyzing written or computer data and observing general
surroundings and activities; work has no exposure to environmental conditions; work is generally in a moderately
noisy location (e.g. business office, light traffic).

3. CenterPoint Human Services (REV. 7/01/2013)
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Please note that this job description should not be construed as an implied employment contract. It is not all
inclusive and does not preclude management from altering duties to meet agency needs. Any questions regarding
this job description should be forwarded to your immediate supervisor.
Supervisor’s Certification: I certify that (a) I am the Immediate Supervisor of this position, that (b) I have provided a
complete and accurate description of responsibilities and duties and (c) I have verified (and reconciled as needed) its
accuracy and completeness with the employee.
Signature Title Date
Employee's Certification: I certify that I have reviewed this position description and that it is a complete and accurate
description of my responsibilities and duties.
Signature Title Date
Department Director’s Certification: I certify that this is an authorized, official position description of the subject
position.
Signature Title Date