Member Support Specialist II

PacificSource; Bend (OR); On-site; USD 36,000 - 57,000; Full time

Job summary

PacificSource is seeking a care coordination-focused professional to help members navigate the healthcare system and maximize benefit usage. You will educate members, coordinate with case managers, and connect them with community resources, while maintaining HIPAA compliance.

The role emphasizes collaboration, documentation accuracy, and the ability to work with diverse teams to improve member outcomes across the health plan.

Qualifications

• High school diploma or equivalent required.
• Minimum three years in community services or healthcare coordination.
• Experience in health insurance and delivering group presentations preferred.
• Proficient in medical terminology and documentation.

Responsibilities

• Coordinate with the member's case manager to develop goals and plans for navigating healthcare.
• Educate members on benefit structures and plan parameters.
• Use motivational interviewing to support healthy outcomes and benefit utilization.
• Identify community resources and provide referrals as appropriate.
• Serve as liaison between members and providers or agencies.
• Assist with referrals, scheduling, and transportation to medical appointments.
• Ensure HIPAA compliance and maintain accurate documentation.
• Participate in case management meetings and contribute to quality improvement.

Skills

Communication

Teamwork

Problem Solving

Organization

Active Listening

Education

High School Diploma

Tools

Microsoft Office

CaseTrakker Dynamo

Job description

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Essential Responsibilities

• In coordination with the member’s case manager, develop and implement goals and/or plans tailored to assist members in navigating the complexities of the healthcare system.
• Educate members on understanding and working within the parameters of their benefit structure.
• Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits.
• Identify community resources and make referrals to members as appropriate.
• Serve as liaison between members and providers/agencies.
• Identify members for coordination and case management services through a variety of methods, including claims data and reports.
• Screen requests to identify appropriate referrals to case management from multiple internal and external sources.
• Work collaboratively with the case management team to help facilitate case management process.
• Participate in case management/care coordination meetings.
• Ensure compliance with applicable state and federal regulations and guidelines in day-to-day activities, including maintaining HIPAA standards and confidentiality of protected health information.
• Ensure accurate and timely documentation.
• Assist members with referrals, scheduling appointments and ensuring transportation to medical appointments is available.
• Assist members with non-clinical needs for transitions and different phases of care.
• Manage mailing lists and outgoing mailings.

Supporting Responsibilities

• Assist with the development of departmental procedures, reports and projects.
• Assist care management to meet quality measures as outlined by government regulations.
• Enter and collate data: prepare reports as assigned.
• Participate in team, department, company, and community-related committees as requested.
• Make presentations to small groups.
• Actively participates in quality improvement initiatives.
• Meet department and company performance and attendance expectations.
• Perform other duties as assigned.

Work Experience

A minimum of three years of experience in community services or healthcare agencies focused on coordination services required. Experience in health insurance and delivering group presentations preferred.

Education, Certificates, Licenses

High school diploma or equivalent required.

Knowledge

• Medical terminology.
• Proficient in Microsoft Office, including Word, Excel, PowerPoint, Medical management software (e.g CaseTrakker Dynamo).
• Excellent verbal and written communication skills and is able to work independently as well as to work effectively on a team.
• Good working knowledge of how to access community resources and healthcare system.

Competencies

• Building Customer Loyalty
• Building Strategic Work Relationships
• Contributing to Team Success
• Planning and Organizing
• Continuous Improvement
• Adaptability
• Building Trust
• Work Standards

Environment

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.

Skills

• Accountability
• Collaboration
• Communication (written/verbal)
• Flexibility
• Listening (active)
• Organizational skills/Planning and Organization
• Problem Solving
• Teamwork

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range: $35,542.81 - $56,868.50

Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements

Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer

This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.