Representative, Mem Svc

Role Summary

The Member Services Representative (MSREP), reporting to the Member Services Manager, is responsible for the verification of insurance eligibility for new and existing patients receiving clinical services within the health center. This includes collection of basic necessary demographic information to initiate the enrollment process and to assess their financial and payer source status. This position has the flexibility to be an onsite position or a work-from-home position, per our telecommuting policy.

Essential Functions

• Handles new patient registration as well as assisting patients in a face-to-face setting which involves creating demographic charts in the Electronic Health Record (EHR) software for members coming to utilize clinical services as well as eligibility inquiries for established patients.
• Provides support to patients regarding Medi-Cal, Medicare and their managed care systems in a clear and professional manner that ensures their understanding.
• Utilizes the Electronic Health Record (EHR) RTS system and/or individual payer websites to obtain eligibility and/or pre-authorization information for next day appointments.
• Refers patients to Certified Enrollment Counselors for enrollment and re-enrollment of Medicaid, Affordable Care Act (ACA), and other state and federal programs.
• Confirms SNAHC is the assigned Primary Care Physician (PCP) with patient insurance plans.
• Notifies appropriate patients of any eligibility conflicts, outstanding balances and/or out-of-pocket costs associated with visits.
• Safeguards all information entered into the Electronic Health Record (EHR) is accurate and complete. This includes reviewing and verifying any paper documents to make sure that all forms are completed, identified, signed and corrected.
• Completes required data entry as it relates to insurance eligibility prior to any services by any provider, must be able to complete this task efficiently and effectively.
• Verifies patients have updated their consents, signature forms and demographic information within the last 12 months, and communicate this in accordance to the process.
• Complies with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA, etc.

Skills And Abilities

• Familiarity with working closely with patients, providing guidance and solutions to complex concerns.
• Familiarity with individual payer guidelines.
• Demonstrated ability to provide excellent customer services to patients.
• Competency in executing assessments of patients needs, to provide efficient care and service.

Competencies

• Communication and Relationships
• Initiative
• Planning and Organizing
• Safety
• Teamwork
• Customer Service
• Data Collection
• Eligibility
• Scheduling

Pay

A reasonable estimate of the current range is $21.00/HR-$23.00/HR.

Schedule

This position may need to float to other SNAHC locations.