Member Service Representative

2 weeks ago

Sacramento, United States Sacramento Native American Health Center Full time

Here at SNAHC, you are joining a team and company at a time of growth and transformation. You will love being surrounded by people who are as passionate as you are about healthcare and giving back to the community. Please note that individual total compensation for this position will be determined at the Company's sole discretion and the wage range for this role considers a wide range of factors including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. At SNAHC, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $18.70-$25.30/HR.

Position Summary:

The Member Services Representative is responsible for the verification of insurance eligibility of 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. As part of the clerical/administration process, they will determine eligibility for public insurance programs, and obtain verification of private insurance as it relates to the patient encounter.

Essential Functions:

  • Answer incoming calls and/or see patients in a face-to-face setting for new patient registration, 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.
  • Provide support to patients regarding Medi-Cal, Medicare and their managed care systems in a clear and professional manner that ensures their understanding.
  • Utilize the Electronic Health Record (EHR) RTS system and/or individual payer websites to obtain eligibility and/or pre-authorization information for next day appointments.
  • Familiarity with individual payer guidelines.
  • Refer patients to on-site Certified Enrollment Counselors for enrollment and re-enrollment of Medicaid, Affordable Care Act (ACA), and other state and federal programs.
  • Confirm SNAHC is the assigned Primary Care Physician (PCP) with patient insurance plans
  • Appropriately notifies patients of any eligibility conflicts, outstanding balances and/or out-of-pocket costs associated with visits.
  • Responsible for ensuring all the 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.
  • Responsible for 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.
  • Compliance with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA etc.
  • Other duties as assigned.
Minimum Qualifications:
  • Must have 1+ year(s) of knowledge and experience working in a clinical front office setting
  • High School diploma or GED
  • Knowledge and/or familiarity of Medicare; Medi-Cal; Presumptive Eligibility; local Geographic Managed Care Plans (GMC); state/federal funded programs for health care enrollment; Sliding Scale.
  • Experience with electronic health records software; NextGen preferred.
  • Excellent computer skills, preferably with Windows.
  • Excellent telephone and communication skills.
  • Must be polite and helpful at all times.
  • Must demonstrate superior professionalism when dealing with clients, staff, and vendors.
  • Ability to work independently, set priorities, and work well under pressure.

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