Member Services Representative, Sr. jobs in California

Asian Health Services, founded in 1974, provides health, social, and advocacy services for all regardless of income, insurance status, immigration status, language, or culture. Our approach to wellbeing focuses on “whole patient health,” which is why we provide more than primary care services, including mental health, case management, nutrition, and dental care to more than 50,000 patients in English and 15 languages: Korean, Lao, Burmese, Mandarin, Cantonese, Spanish, Portuguese, French, Mien, Karen, Mongolian, Karenni, Tagalog, Khmer, and Vietnamese.

We offer medical, dental, and mental health services for all ages.

LOCATION: HMC

JOB SUMMARY:

With supervision from the Senior Member Services Manager, learns to determines initial and continuing eligibility for health and social services by screening and interview patients to assess financial payer sources and status.

Entry Level: This is the entry-level for this job.   Initially, under close supervision, incumbents learn to determine and administer cases.

As experience is gained, the caseload is expanded and incumbents are expected to perform more independently.  

Intermediate Level: This is the experienced level for this job, fully competent to perform the full range of duties under minimal supervision.  Policies, procedures, and guidelines are provided and supervision is available for consultation under unusual circumstances.

• Conducts patient financial screening to determine eligibility for County Medical Services Program (CMSP), Medicare, Medi-Cal, Healthy Families, and other payment sources.
• Assists patients in completing forms and applications for payment programs.  Follows up on patients’ pending status for payment programs.
• Assists patients in selecting a primary care provider and a health insurance plan, including PPO and HMO.
• Contacts health plan and insurance company to verify patients’ insurance coverage and referral requirement; may assist in completing Medi-Cal applications and perform status follow-up with the county’s Medi-cal worker.  
• Answers inquiries and provides counseling regarding Medi-Cal and Medicare and their managed care systems, and other social service needs.
• Update patient financial information in the computer system and follow up on patients’ pending status for a payment program, 
• Answer incoming phone calls that are directed to the Member Services Department and make appointments for members.  
• Assists the Member Services Manager in conducting member exit interviews and in processing monthly member rosters for all AHS’ contracted managed care plans.
• Provide input to Member Services Manager in developing and maintaining eligibility criteria and procedures consistent with AHS goals and objectives.
• Provides advocacy for AHS patients/members due to government welfare reform and immigration policies.
• Conduct medical history intake interviews for all patients including new patients, newborn infants, and perinatal patients.

• Meets regularly with Member Services Manager to discuss patient eligibility problems and/or other issues affecting the department.
• May provide back up for the front desk patient services representative, interpreting services, and Saturday clinic as requested.
• May provide back up for Member Services Manager (Level II only), solving complex problems as necessary.
• Assists the Billing department regarding billing problems as requested.
• May attend staff and department meetings, as well as special training sessions related to new eligibility criteria for payor programs.
• May participate in special AHS internal committees and task forces, as appropriate.
• [For Intermediate Level] May act as lead and troubleshoot on issues for Billing department staff, Patient Services Representatives, Providers, and Medical Interpreters.
• Perform other duties as required.

• [Entry Level] High school diploma or GED with two years related work experience in a community health setting; or equivalent combination of education and experience 
• [Intermediate Level] High school diploma or GED with two years of college course work in a related field and two years related work experience in a community health setting; or equivalent combination of education and experience 

• Bilingual/bicultural in Cantonese preferred.
• Commitment to working in the Asian community, to community health care with familiarity with community health clinics preferred.
• Health Families certification preferred 

• HIPPA Training Certificate

BENEFITS:

Medical, Dental, Vision premiums 100% paid by AHS

12 Vacation Days

12 Sick Days

12 Holidays and 3 Floating Holidays

3% 403B Employer Contributions and up to 2% Employee Match Contribution

Transportation Benefit Paid by AHS

FSA/Dependent Care Assistance

Long Term Disability