Representative, Mem Svc

Sacramento Native American Health Center, Inc.; Sacramento (CA); Hybrid; USD 28,929 - 31,684; Full time

Job summary

Sacramento Native American Health Center, Inc. is seeking a Member Services Representative to verify insurance eligibility for patients, collect demographic data, and assess financial/payer status within our health center. The role can be onsite or work-from-home per policy.

The MSREP will determine eligibility for public programs, obtain private insurance verification, and guide patients on enrollment options. Strong customer service and accuracy are essential.

Qualifications

• Experience in patient registration and use of EHR systems.
• Knowledge of Medi-Cal, Medicare and managed care programs.
• Ability to verify insurance eligibility and pre-authorization information for next-day appointments.

Responsibilities

• Register new patients and create demographic charts in the EHR for clinical visits.
• Assist patients with insurance questions and payer sources.
• Use EHR RTS and payer sites to obtain eligibility and pre-authorization details for next-day appointments.
• Refer patients to Certified Enrollment Counselors for Medicaid/ACA enrollment.
• Confirm SNAHC as the assigned PCP with patient insurance plans.
• Notify patients of eligibility conflicts and out-of-pocket costs.
• Ensure all information in the EHR is accurate and all forms are completed and signed.
• Complete required data entry related to insurance eligibility prior to services.
• Verify that consent and demographic information are up-to-date within 12 months.
• Comply with HIPAA, OSHA, and other laws and regulations.

Skills

Customer service

Eligibility assessment

Data entry

Communication

Compliance knowledge

Payer guidelines familiarity

Tools

EHR RTS

Job description

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 $21.00/HR-$23.00/HR.

Position Summary

The Member Services Representative (MSREP), reporting to the Member Services Manager, is responsible for the verification of insurance eligibility for 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. This position has the flexibility to be an onsite position or a work-from-home position, per our telecommuting policy.

Essential Functions

• Handles new patient registration as well as assisting patients in a face-to-face setting 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.
• Provides support to patients regarding Medi-Cal, Medicare and their managed care systems in a clear and professional manner that ensures their understanding.
• Utilizes the Electronic Health Record (EHR) RTS system and/or individual payer websites to obtain eligibility and/or pre-authorization information for next day appointments.
• Refers patients to Certified Enrollment Counselors for enrollment and re-enrollment of Medicaid, Affordable Care Act (ACA), and other state and federal programs.
• Confirms SNAHC is the assigned Primary Care Physician (PCP) with patient insurance plans
• Notifies appropriate patients of any eligibility conflicts, outstanding balances and/or out-of- pocket costs associated with visits.
• Ensures all 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.
• Completes 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.
• Complies with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA, etc.
• Other duties assigned.

Skills And Abilities

• Familiarity with working closely with patients, providing guidance and solutions to complex concerns.
• Familiarity with individual payer guidelines.
• Demonstrated ability to provide excellent customer services to patients.
• Competency in executing assessments of patients needs, to provide efficient care and service.

Competencies

• Communication and Relationships
• Initiative
• Planning and Organizing
• Safety
• Teamwork
• Customer Service
• Data Collection
• Eligibility
• Scheduling