Representative, Mem Svc

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

Job summary

Sacramento Native American Health Center (SNAHC) is seeking a Member Services Representative to verify insurance eligibility for patients receiving clinical services. The role involves collecting demographic information to start enrollment, assessing payer status, and determining eligibility for public programs.

The MSREP will work with the EHR system, coordinate with enrollment counselors for Medicaid/ACA enrollment, and ensure accurate data entry.

Qualifications

• 1+ year in clinical front office setting.
• Knowledge of Medicare/Medi-Cal and related programs.
• Professionalism when working with clients, staff, and vendors.
• Ability to operate EHR systems and protect patient data.

Responsibilities

• Handles new patient registration and creates demographic charts in the EHR.
• Provides guidance on Medi-Cal, Medicare and managed care systems.
• Uses EHR RTS or payer sites to obtain eligibility and pre-authorization for next-day appointments.
• Refer patients to Enrollment Counselors for Medicaid/ACA enrollment.
• Ensures accurate data entry in the EHR and verifies updated consents and demographics.

Skills

Customer service

Payer guidelines

Front desk experience

HIPAA knowledge

Education

High School diploma or GED

Tools

NextGen

Job description

Job Details

Job Location: 2020 J Street - Sacramento, CA 95811

Salary Range: $21.00 - $23.00 Hourly

About SNAHC

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.

Role may need to float to other SNAHC locations.

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

Qualifications

Minimum Qualifications

• Must have 1+ year(s) of knowledge and experience working in a clinical front office setting
• High School diploma or GED
• Knowledge and/or familiarity of Medicare; Medi-Cal; Presumptive Eligibility; local Geographic Managed Care Plans (GMC); state/federal funded programs for health care enrollment; Sliding Scale
• Ability to demonstrate superior professionalism when working with clients, staff, and vendors.

Preferred Qualifications

• NextGen Experience
• Bilingual
• Excellent computer skills, preferably with Windows.
• Knowledge of traditional, cultural, and spiritual practices of the diverse AI/AN community, as well as ability to work with other racially, culturally ethnically, and financially diverse populations.

Grant Funding Note

Please Note: This position may be grant funded. Continued employment is contingent upon renewed or additional funding and may be discontinued at the close of the grant cycle. Grant funding for any position does not impart any contractual right, either expressed or implied, to remain in Sacramento Native American Health Center, Inc.’s employment for a specific period of time. Grant funding does not affect the Sacramento Native American Health Center, Inc.’s status as an “at will” employer.