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Member Support Specialist

4 months ago

Adamsville, United States Complete Health Full time
Job Description

Monday - Friday, Full Time

Pay: $21 - $23/hr

The Member Support Specialist (MSS) directly engages and assists the Member Support Representative (MSR) within the assigned clinic(s). The MSS role acts as an extension of the MSR internally and externally when necessary.

Duties and Responsibilities Include:

  • Identifies internal members and works cohesively with MSR for conversion into Value Based Care (VBC) Medicare Advantage and/or Medicaid (Duals) plans through Point of Care Opportunities (POC).
  • Age-In Report
    • Handwrites Birthday Cards
    • Obtains signatures from MSR and Clinical team.
    • Include MSR/MSS Business Card in birthday card for mailout.
  • Traditional Medicare Appointment Lists
    • (Reviews and omits Tricare/ChampVa/Retirement Plans)
  • Manages leads from Events/Marketing
    • Schedule tours and conducts tours as needed.
    • Schedule New Patient and Annual Wellness Visits (AWV) appointments.
    • Updates leads in data base.
    • Updates new member Value Based Care Medicare Plan in data base.
  • Follow up mailout campaigns and schedule clinic tour and first appointment.
  • Member Concerns
    • Update Primary Care Physician (PCP) Assignments
    • Transportation Concerns
    • Patient Assistance Programs (PAP)- Medication Concerns
    • Reminders Notifications
  • Creates SlyBroadcast for various conversion list opportunities
  • Contacts each Medicaid-Medicare member/potential member personally.
    • Obtain Consent to Contact (CTC)
    • Connect potential member with Broker/Agent for consultation.
    • Follow-up with Broker/Agent for Medicaid process updates.
    • Updates member in data base and Athena medical records system.
  • MSS Member Engagement
    • Engages with new patients after first appointment.
    • Continues engagement to assist member in all concerns.
  • MSS Member Management
    • Enters/Upkeeps Athena system, payor rosters, spreadsheets leads and contacts.
    • Changes insurance for Value Based Care members in Athena system.
    • Creates patient cases when necessary.
      • Medication refills, clinical questions, referral questions, etc,)
      • Inactivates Deceased and Inactive Patients.
      • Conducts In clinic Complete Health 360 conversation for potential new members.
      • Documents Social Determinants of Health (SDoH) in Athena.
      • Conducts Patient Assistance (PAP) reviews with existing Value Based Care members and potentials.
      • Educate/offer assistance on state's Medicaid programs.
    • Answer phones, follow-up on voicemails, make outbound calls to existing/potential new members.
    • Meets with patients in office to conduct:
      • Complete Health 360 assessment and map to Social Determinants of Health (SDoH) within the EMR (Athena);
      • Educate and Offer Assistance on State's Medicaid Programs for Medicare Eligibles;
      • Patient Assistance Program (PAP) reviews;
    • Partners with MSR to determine team goal within assigned clinic for Value Based Care Medicare Advantage and/or Medicaid/Duals new member enrollment.
    • MSS spends 90% of time within their office(s). 10% of time assisting with events/outreach led by MSR.
Preferred Experience Skills:
  • Service-excellence oriented in a healthcare setting and support of Value Based Care Medicare Advantage. (e.g. senior settings, dental offices, primary care)
  • Knowledge of Medicare plans including Medicare Advantage HMO, PPO, C-SNP, D-SNP; Duals (Medicaid Medicare)
  • Experience on member roster reconciliation, including outreach for retention and verification.
  • Excellent communication skills via e-mail, chat, phone, written correspondence.
  • Experience supporting events on and off-site, including occasional evening and weekend hours.
  • Ability to provide service excellence in all duties and responsibilities.
    • Tour and guide members/potential members to services within clinic.
    • Guide members to resources outside clinic.
Requirements

MINIMUM REQUIREMENTS
  • Service-excellence oriented in a healthcare setting (e.g., senior diabetic, dental offices, primary care, etc.) or health-plan support of Medicare Advantage to doctors' offices and staff;
  • Knowledge of various Medicare plans, including Medicare Advantage HMO, PPO, C-SNP, D-SNP;
  • Demonstrated experience on member roster reconciliation, preferably in MS Excel;
  • Outreach via email, chat, phone, written correspondence;
  • Experience supporting member events on off-site, including occasional evening weekend hours;
  • Ability to give tours and guide members to services both within the clinic and within the member's health-plan, as well as outside agencies.


WORKING ENVIRONMENT

The position requires climbing, stooping, kneeling, crouching, reaching, standing, lifting, grasping, feeling, talking, hearing, repetitive motions, and finger use. Pushing and pulling are occasionally required. Use of a computer, keyboard, and telephone along with various office machines is an essential part of the job.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by the Member Support Specialist. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The Member Support Specialist may be required to perform duties outside of their normal responsibilities from time to time as needed or as directed by supervision.