Member Services Rep.-Crescent City - OTF

SUMMARY:

This position shall be responsible for the registration process and for assisting United Indian Health Services (UIHS) clients with eligibility and application into various health benefit programs. This position will also be responsible for initiating, tracking, processing and reporting the status of all benefit applications.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Ability to handle difficult or confrontational situations in a calm, consistent, and equitable manner.

• Meets one-on-one with clients to provide information on available health benefit programs and assess client eligibility parameters. Facilitate the coordination of client’s health information with the facility and with their insurance companies and other payers.
• Coordinates and utilizes an effective system of communication throughout UIHS, with caregivers, and external insurance agencies to complete application process for clients.
• Establish and maintain constructive working relationships.
• Tracks and prepares reports on the number of applications processed as well as number of incomplete applications pending additional information monthly and submit to the Member Services Specialist. .
• Provides timely follow-up on the approval or denial of client applications.
• Assists clients with clinic initiatives including Patient Portal sign up, distributing election forms, client experience surveys, etc.
• Participates in quality improvement activities as assigned.
• Prioritizes entry of family intakes for clients needing Purchased/Referred Care services.
• Note all significant client interactions in their electronic health file
• Maintain appropriate files and documents..
• Attend organizational committee meetings and other meetings as assigned.
• Maintain professional, organized, and clean working environment by following organizational policies, guidelines, and safety standards.
• Adheres to accreditation and compliance standards/guidelines.
• Attends seminars or training sessions appropriate for maintaining up-to-date knowledge.
• Answers telephone in a courteous and efficient manner. Gives information to callers or routes calls to appropriate person or section.
• Operates various office equipment including a photocopier, calculator, fax machine, computer, printer, and any other office equipment to perform tasks as needed.
• Performs other tasks as assigned.

SUPERVISORY RESPONSIBILITIES: This position has no supervisory 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

Level I: High School diploma, GED or equivalent. 1 year of clerical office or related experience that indicates the ability to learn the skills necessary to perform the duties of the position. Be willing to assist clients with enrollment or application into multiple programs including but not limited to: Presumptive Eligibility, Family Pact, CHDP and/or Angel fund assistance. Track and follow up all enrollment applications processed. Begin the process to become a certified application counselor. Ability to work independently and as part of a team. Customer service experience preferred.

Level II: Must meet or exceed all level I criteria and have 1-3 years’ experience working with health benefit plans, enrollment processes or other related areas. Knowledge of available health benefit plans and have the ability to perform the duties of the position. Ability to enroll clients in multiple programs: Covered CA (Affordable Care Act), Medi-Cal, Presumptive Eligibility, Medicare Part D, Family Pact, CHDP, Angel Fund, pharmacy assistance programs, or any other health benefit program. Must be certified and maintain certification to assist clients with enrollment and re-enrollment activities for all health benefit programs (i.e. certified application counselor). Experience in a health care setting preferred.

Level III: Must meet or exceed all level I & II criteria and have 3 or more years of related experience and/or training working with health benefit plans and/or enrollment processes and have the ability to perform all the duties of the position.. Able to assist with training level I staff on all available health benefit programs and documentation requirements. Assist with documenting standard operating procedures as necessary. Experience in a health care setting preferred.

COMPUTER OPERATIONS

• Intermediate personal computer skills, including electronic mail, routine database activity, word processing, spreadsheet, graphics, etc.

LANUGUAGE SKILLS:

• 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.

MATHEMATICAL SKILLS:

• Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

REASONING ABILITY:

• 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.

CERTIFICATES, LICENSES, REGISTRATIONS:

• Must possess a valid drivers’ license.
• Must be able to be insured under the agency’s vehicle policy.
• Levels II and III must be certified and maintain certification to assist clients with enrollment and re-enrollment activities for all health benefit programs (i.e. certified application counselor).

OTHER SKILLS AND ABILITIES:

• Demonstrate ability to work with people in collaborate manner, including a variety of agencies.
• 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.
• Must be able to type a minimum of 45 WPM.
• 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.