Member Services Representative

Accurate Personnel LLC; Houston (TX); On-site; USD 22,000 - 32,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

Job summary

Accurate Personnel LLC in Houston, TX is hiring a Member Services Representative to resolve physician/provider issues via the client portal. This full-time role requires knowledge of QNXT modules and strong communication skills to support providers and members.

You will educate new providers, track issues, and collaborate with network management to improve service, while maintaining detailed documentation and excellent customer service standards.

Qualifications

• High School diploma or GED required.
• Bachelor’s degree in Business preferred.
• 2 years experience in Managed Care (Provider Relations/Services Contracting; in Claims Adjudication/Medical Coding).
• MS Office (Word, Excel, Outlook) proficiency.
• Strong verbal and written communication skills.
• Able to lift up to 20 lbs occasionally.

Responsibilities

• Resolve physician/provider issues via client portal and internal teams.
• Follow up with physicians/providers and document transactions per policy.
• Investigate and resolve member complaints including wait times and TX guidelines.
• Respond to QNXT call tracking and track issues referred to network management.
• Provide initial educational materials to new physicians/providers.
• Offer ongoing telephonic support and education on portal usage.

Skills

Customer service

Verbal and written communication

Problem analysis

Attention to detail

Teamwork

Adaptability

Education

High School diploma or GED

Bachelor's degree in Business

Tools

Microsoft Office

Job description

HIRING IMMEDIATELY: MEMBER SERVICES REPRESENTATIVE IN HOUSTON, TX 77081

Accurate Personnel is hiring immediately for a Member Services Representative to join our team in Houston, TX. This individual will resolve Physician and /or Provider focused issues (educational needs, contract verification, participation status, claims payment discrepancies, interaction) with the clients provider portal. The ideal candidate will have working knowledge of the designated QNXT referral, claims, eligibility, and provider modules, as well as all CACTUS modules and serve as the primary party responsible for responding to QNXT call tracking issues referred to Network Management.

Pay, Schedule, and Location

• Ranging to $19.69/hour
• Full Time Schedule
• Excellent benefits package, including medical, dental, and vision
• Located in Houston, TX 77081

Duties and Responsibilities

• Resolves Physician/Provider focused issues as received from internal parties, on an independent basis versus relying on a third party, except when claim adjustments are warranted
• Effectively follows-up with Physicians/Providers as it relates to questions forwarded by network management or other internal staff, comprehensively documents transactions in compliance with the clients policy
• Investigating and resolving Member complaints against Physicians/Providers, as received by Member Services Department or Compliance, including but not limited to; appointment wait times and violations of TX Provider Marketing Guidelines
• Serves as the primary party responsible for responding to QNXT call
• Tracking issues referred to network management
• Ensures new Physicians/Providers receive, and reviews with new Physicians/Providers required initial educational materials, i.e., provider manual, quick reference guide, etc.
• Provides ongoing individual telephonic support & education of Physicians/Providers on relevant topics, including but not limited to, identified claims and/or authorization issues, new initiatives, availability, and functionality of the clients portal, etc
• Remain knowledgeable of components in the clients engagement platform
• Collaborating with leadership, co-workers, and staff in other departments
• Demonstration of good communication and interpersonal skills

Requirements and Qualifications

• High School or GED required
• Bachelors of Arts/Bachelors of Science, in Business preferred
• 2 years experience in Managed Care (Provider Relations/Services Contracting; preferably in Claims Adjudication, Medical Coding)
• Microsoft Office (Word, Excel, and Outlook)
• Office setting with low partitions and open floor plan
• Customer service skills such as reliability, integrity, teamwork, and change management, plus strategic vision and team development for supervisory roles
• Exceptional verbal and written communication skills
• Problem analysis and strong attention to detail
• Able to lift up to 20lbs occasionally
• Work in a high-rise building
• Close paper/computer work

Accurate Personnel provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

HTB