Scope of Work:
The District of Columbia Government, hereby referred to as the District, Office of Contracting and Procurement, on behalf of the Department of Health Care Finance, requires a bidder to provide one (1) temporary staffing resource (Customer Service Representative) to assist the District with transitioning enrollees between managed care organizations (MCO).
· The Contractor shall assist with completing requests to select another MCO as received from enrollees during the Open Enrollment period.
· The Contractor shall manage calls received through an Enrollee Hotline designated for enrollees requesting to transfer to another MCO.
· The Contractor shall answer calls received through the queue and collect the transfer request(s) received from the enrollee.
· The Contractor shall document the request(s) on an electronic form as specified by DHCF and subsequently complete the request in the Medicaid Management Information System (MMIS).
· The Contractor shall have access to the District’s eligibility systems – Automated Client Eligibility Determination System (ACEDS), District of Columbia Access System (DCAS) and MMIS to accurately complete enrollment requests as described in 5.2.2.
· The Contractor shall accept requests to transfer to another MCO received from enrollees by other staff and Administrations within DHCF.
· The Contractor shall provide a daily account of the number of requests received and completed, and corresponding identification of each FROM MCO and TO MCO, to the Director of the Health Care Delivery Management Administration (HCDMA).
· The Contractor will complete all required and necessary trainings on use of the Enrollee Hotline, MMIS and tool(s) for documenting MCO reassignments prior to entering any changes into the appropriate system(s).
· A script for managing calls received through the Enrollee Hotline will be provided in no less than two (2) days prior to logging into the queue.
· MCO Reassignment Schedule
· Enrollees Retroactive enrollment requests for Oct 1 will cease on Oct 15
· Retroactive enrollment requests for Nov 1 will occur from Oct 16 through Nov 15
· Retroactive enrollment requests for Dec 1 will occur from Nov 16 through Dec 15
· The Contractor shall have 3 – 5 years’ data entry experience and advanced knowledge of enrollment and eligibility systems such as the District’s systems, ACEDS, DCAS and MMIS.
· The Contractor shall provide documentation that ensures a completed onboarding background check for the resource selected to perform services for the District under this contract was performed. The background check criteria shall include, at a minimum, the following:
a) Criminal record check
b) Education record – degrees and certifications
c) Professional credentials
d) Personal references
e) Military record
f) Social Security traces