Job Opportunities in United States
November 19, 2024
United Indian Health Se
Arcata
Member Services Specialist - PHV - Close Date: 12.02.2024
SUMMARY:
This position shall be responsible for leading and training of the Member Services Representative staff. The Member Services Specialist will actively work with the Member Services Representatives to provide continuity of services to United Indian Health Services (UIHS) clients with eligibility and enrollment into various health benefit programs. This position will also be responsible for the registration process; coordinating and overseeing the tracking process and reporting the status of all health benefit applications from the Member Services Representative staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION/EXPERIENCE: Educational degrees must be from a US Department of Education accredited school
This position shall be responsible for leading and training of the Member Services Representative staff. The Member Services Specialist will actively work with the Member Services Representatives to provide continuity of services to United Indian Health Services (UIHS) clients with eligibility and enrollment into various health benefit programs. This position will also be responsible for the registration process; coordinating and overseeing the tracking process and reporting the status of all health benefit applications from the Member Services Representative staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Under direction of the Member Services Manager the Member Services Specialist will directs the day-to-day operations of the Member Services Representative staff.
- Oversees and maintains continuity of the registration process and coordinates all updates with Member Services Representatives.
- Coordinates the Member Services Representative staff and works with the Member Services Manager to standardize processes and identify knowledge gaps among staff for ongoing training. Collects and prepares reports on the total applications processed from each Member Services Representative as well as number of incomplete applications pending additional information. These numbers are to be prepared and reported monthly to the CFO or Member Services Manager.
- Demonstrates excellent customer service skills.
- Attends organizational committee meetings and other meetings as assigned.
- Ensures clients meet eligibility for services at United Indian Health Services.
- Provide information to clients on available health benefit programs, their eligibility parameters and provides assistance for the completion of benefit applications.
- Coordinates and utilizes an effective system of communication throughout UIHS, with caregivers, and external insurance agencies to complete application process for clients.
- Establishes and maintains constructive working relationships with clients and all levels of employees.
- Handles difficult or confrontational situations in a calm, consistent, and equitable manner.
- Demonstrates knowledge of available health benefit programs, enrollment and re-enrollment processes.
- Maintains a professional, organized, and clean working environment by following organizational policies, guidelines, and safety standards.
- Adheres to accreditation and compliance standards/guidelines.
- Attends training appropriate for maintaining up-to-date knowledge of required skills and based on these trainings shares relevant information with the Member Services or other staff.
- Operates various office equipment including a photocopiers, calculator, fax machine, computer, printer, and any other office equipment to perform tasks as needed.
- Performs other tasks as assigned.
- Review family intakes screening them for eligibility into available health benefit programs.
- Assist eligible clients with the enrollment applications for health benefit programs and to ensure the process is complete.
- Assist clients with completing appropriate forms for continued eligibility into health benefit programs and case management as required.
- Maintain appropriate files and documents. .
- Prepare monthly reports and documents used to identify trends on services provided and client insurance needs.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION/EXPERIENCE: Educational degrees must be from a US Department of Education accredited school
- Must have High School Diploma or equivalent. .
- Must have 4 or more years of current related experience and/or training working with health benefit programs including enrollment and re-enrollment. Must be certified and maintain certification to assist clients with enrollment activities for all health benefit programs including but not limited to Covered CA (Affordable Care Act). Must have the ability to successfully lead the Member Services team under the direction of the Member Services Manager. Must have excellent customer service skills and have the ability to perform all the duties of the position. Must have the ability to work both independently and as part of a team. Experience in a health care setting required.
- Intermediate personal computer skills, including electronic mail, routine database activity, word processing, spreadsheet, graphics, etc.
- Must be able to type 45 WPM.
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
- Ability to write routine reports and correspondence.
- Ability to speak effectively before groups of customers or employees of organization.
- Ability to work with mathematical concepts such as probability and statistical inference.
- Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
- Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
- Ability to deal with problems involving a few concrete variables in standardized situations.
- Must possess a valid drivers’ license.
- Must be able to be insured under the agency’s vehicle policy.
- Ability to operate standard office equipment (copier, fax, etc.).
- Must be able to work with American Indian people and be sensitive to their culture.
- Comply with all safety policies, practices and procedures. Report all unsafe activities to supervisor and/or Human Resources.
- Participate in proactive team efforts to achieve the Mission, Vision and Guiding principles of UIHS.
- Provide leadership to others through example and sharing of knowledge/skill.
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