Member Services Coordinator II - 7D

Native American Health Center, Inc.; Oakland (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Native American Health Center, Inc. in Oakland, CA is seeking a Member Services Coordinator II for the Member Services Department.

This on-site role supports member access to services across Medical, Dental, and Mental Health programs, coordinates appointments, and helps identify funding sources to cover treatments. The MSC II will review member accounts, train other MSC staff, and ensure accurate registration in the PMS and member portal.

Qualifications

• Knowledge of clinical terminology and treatments.
• Experience enrolling members in publicly-funded programs.
• Ability to explain insurance and benefits to members.
• Experience working in healthcare settings.
• Strong data entry and documentation in an electronic health record (EHR).

Responsibilities

• Greet members and manage appointments in a courteous, professional manner.
• Schedule and confirm appointments; inform members of processes and procedures.
• Proactively manage appointment scheduling to maximize productivity and fill gaps.
• Manage voicemail system and ensure timely routing of messages.
• Make reminder calls and inform members of outstanding balances.
• Answer inquiries about financial responsibility, insurance, and benefits.
• Register members in the PMS and update registration information annually.
• Assist with eligibility screening for care coverage and enrollment in programs.
• Coordinate private insurance benefits with providers and update payer codes.
• Follow procedures for collecting payments and issue receipts.
• Verify insurance eligibility prior to scheduled appointments; communicate changes.
• Assist with language translation for healthcare services.
• Participate in quality improvement teams and support safety policies.
• Attend Saturday and after-hour clinics as assigned.

Skills

Customer service

Scheduling

Insurance coordination

Medical terminology

HIPAA/compliance

Tools

Practice Management System (PMS)

OneEapp

CalHeers

Covered CA portals

Job description

POSITION: Member Services Coordinator II
DEPARTMENT: Member Services
LOCATION: Native American Health Center (NAHC)
2950 International Blvd, Oakland, CA 94601
WORK HOURS: Full Time, 40 hours per week, 100% FTE
STATUS: Union, Non-Exempt

POSITION: Member Services Coordinator II
DEPARTMENT: Member Services
LOCATION: Native American Health Center (NAHC)
2950 International Blvd, Oakland, CA 94601
WORK HOURS: Full Time, 40 hours per week, 100% FTE
STATUS: Union, Non-Exempt

Position Summary

The Member Service Coordinator II (MSC II) works as a part of a multi-disciplinary team of individuals who provide high quality member care. The MSC II must be able to accept and adhere to guidance and direction from multiple levels of management. The MSC II will work with members to identify appropriate funding sources that may cover the cost of treatments and enroll members in publicly-funded programs to determine fees and co-payments as needed. This position requires knowledge of clinical terminology and treatments and is responsible for assisting members with accessing services within NAHC Medical, Dental, and Mental Health Departments. The MSC II will assist with member account review and will assist in training and support of other MSC within the Member Services Department.

The Native American Health Center is an accredited institution and adheres to the standards of excellence set forth by the Accreditation Association of Ambulatory Health Care (AAAHC) and the Commission of Dental Accreditation (CODA).

Duties And Responsibilities

• Greet all members in a courteous and professional manner to create and maintain a welcoming atmosphere.
• Schedule member appointments appropriately, answer and return telephone calls in a timely manner, and inform members of processes and procedures.
• Proactively manage and “tetris” appointment scheduling to maximize productivity and to fill appointment gaps.
• Manage the voicemail system, which includes: create and update greetings as appropriate; check messages often and ensure messages are routed appropriately and activate the voice message system at appropriate times.
• Make member appointment reminder calls the day prior to the appointment to confirm, and notify members of any outstanding balances on their accounts.
• Answer member inquires about financial responsibility, insurance and benefits, account status, and treatment planning.
• Receive and deliver messages to providers, ensure all stakeholders are aware of schedule changes, distribute member appointment schedules daily, prepare charts/documents, and inform the provider of outstanding payments that pertain to services requiring payment i.e. Dental Labs.
• Register members into the practice management system (PMS) in a manner that ensures accuracy and thoroughness and update member registration information once per year at minimum, or as information changes. Inform members of Notice of Privacy Practices and obtain the members signed acknowledgement statement.
• Register members into NAHC member portal. Provide user support and education on portal functionality.
• Manage NAHC member portal appointment request and member messages.
• Screen members’ eligibility for possible care coverage (e.g., county or state programs; sliding scale.) Inform members of program limitations and ensure member understands the information being conveyed.
• Enroll members into appropriate publicly-funded programs and follow enrollment and program guidelines. Coordinate private insurance benefits with the member and the provider.
• Responsible for entering accurate assigned payer codes in (PMS), entering expiration dates according to guidelines, terminating inactive payer codes, and select appropriate payers codes for services.
• Follow NAHC procedures when collecting payments from members and issue a receipt every time. Inform appropriate staff of payment status.
• Confirm members’ insurance eligibility on all scheduled appointments at least two days prior to scheduled appointments. Notify members in a timely manner of changes to insurance benefits.
• Coordinate Private Insurance benefits with the member and the provider by; verifying coverage/benefits, limitations, waiting periods, pre-authorizations, and financial responsibility.
• Check-in members for their scheduled appointments in a timely manner and complete all flows for the member appointment such as; verifying member demographics, processing payments, insurance verifications, payer code selection, printing encounter labels, and pulling charts as appropriate.
• Conduct member financial screenings to determine their eligibility for County Medical Services Program (LIHP/ACE); Medicare; Medi-Cal; Healthy Families; State Office of Family Planning (SOFP); Presumptive Eligibility; Alameda Alliance for Health-AAH Family Care; and other payment sources
• Use OneEapp/CalHeers/Covered CA Portals as a means to determine eligibility and enroll into eligible programs
• Provide Covered CA education on available plans/metal tiers clients are eligible to enroll in.
• Follow all enrollment criteria, eligibility rules/requirements, and maintain certification of any and all Federal, State, County health programs NAHC is required to follow.
• Assist members with completing forms and applications for various payment programs.
• Create and review member account alerts and flags for account status, identifying programs, service locations, treatment related notations, banned member status, etc.
• Participate in Saturday clinics and after-hour clinics, on a rotating basis, as assigned by Supervisor.
• Document member contact by telephone, in person, by mail as appropriate in electronic health record.
• Log and reply in a timely manner to health record requests for chart notes, radiograph copies, lab results and ensure they are compliant with HIPPA policies and procedures.
• Respond in a timely manner to Billing department inquires; answer necessary treatment-related Billing questions and correct MIRs (Missing Information Registration) and return in a timely manner, and assist in the process of correcting MID/MIM (Missing information Dental/Medical) encounters.
• Assist in the quality assurance and timely submission of encounter forms, as requested.
• Assist with language translation as needed for healthcare services.
• Actively participate in internal quality improvement teams to drive initiatives in accordance with the mission and strategic goals of the organization.
• MSC’s are assigned appropriate duties as it relates to specific sites, programs, and departments. These duties may include data entry, maintaining logs, generating reports, invoicing for payments and grants, ordering supplies, scheduling pick-ups and deliveries, maintaining active/inactive charts, sort mail, attend meetings, assisting in audits, and supporting satellite clinics.
• Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices.
• Employee Safety: Safely performs all duties; follows required protective protocols
  

to ensure personal safety as well the safety of others.

• Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
• Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned.
• Work well under pressure, meet multiple and often competing deadlines.
• At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
• Other duties as assigned by Supervisor.