Member Support Specialist

3 weeks ago

Cullman, United States Complete Health Full time
Job Description

Schedule: Monday - Friday

Pay: $22.00 - $24.00/hr

SUMMARY OF JOB DUTIES:

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

ESSENTIAL JOB FUNCTIONS:

  • Identifies internal members, relations to work cohesively with MSR for conversion into HMO through Point of Care Opportunities
  • Age-In Report
    • Handwrites Birthday Cards
    • Obtains signatures from MSR/MSS, PM and Care Team
    • Include MSR/MSS Business Card
  • Traditional Medicare Appointment Lists
    • (Reviews and omits Tricare/ChampVa/Retirement Plans)
  • Leads from Events/Marketing
    • Schedule Tours, conducts Tours if MSR off-site
    • Schedule New Patient Annual Wellness Visits (AWV) Appointments
    • Updates the "Leads" tab on the MSR Master Spreadsheet (MS Excel)
    • Updates MSR Master Spreadsheet if patient selects a Value-Based Medicare Plan
  • Mailout Campaigns (schedule tours/first appointments)
  • Member Issues
    • Primary Care Physician (PCP) Assignments
    • Transportation
    • Patient Assistance Programs (PAP)
    • Reminders Notifications
  • Creates Slybroadcast for various conversion list opportunities
  • Contacts each Medicaid-Medicare personally
    • Obtain Consent To Contact (CTC)
    • Contact Broker/Agent
    • Follow-up with Broker/Agent
    • Updates MSR Master Spreadsheet ("leads" tab) and Athena medical records system
  • The MSS engages with new patients after MSR has scheduled first appointment through and beyond for retention
  • The MSS manages, upkeeps the Athena system and associated rosters/spreadsheets with new leads and contacts assigned to MSR
  • Enter New VBC Patients and New Medicare Patients including scheduling New Patient Appointment and Annual Wellness Appointment
  • Change insurance in EMR system from non-VBC Plan to VBC Plan
  • Create Patient Cases when necessary (Rx refills, clinical questions, referral questions, etc)
  • Inactivate Deceased and Inactive Patients in EMR system (includes PCP changes, move out of area status)
  • Report Building/Library (ties into those turning 65(T65) and Medicaid/Medicare) as requested/needed by MSR
  • The MSS engages with new patients after MSR has scheduled first appointment through and beyond for retention
  • Answers phones, follow-up on Voicemails
  • Meets with patients in office to conduct:
    • Complete Health 360 assessment
    • Patient Assistance Program (PAP) reviews
    • Annual renewal of PAPs
  • The MSS works in partnership with he MSR to obtain a team Medicare Advantage enrollment goal per their center(s) assigned
  • The MSS ideally spends 90% of their time within their office(s), 10% assisting with events/outreach led by MSR
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.

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