Member Services Representative

POSITION SUMMARY

The Member Services Representative will ensure medical necessity compliance, verifying eligibility and posting payments.

POSITION DUTIES

• Obtain demographic, insurance, and financial information from members or guarantor. Enters information in computer system with a high degree of accuracy.

• Explains all required forms to the member or guarantor and obtains the necessary signatures.

• Ensures medical necessity compliance by obtaining necessary data.

• Communicating information to members or guarantor and obtaining necessary signatures.

• Protect the financial integrity of the facility by collecting member liability, establishing payment arrangements, discussing payments options and screening for eligibility.

• Collects and copies member ID, Social Security cards (if child, SS cards for both parent/guardian & child), Insurance card (front & back), Birth Certificate (for children). Obtain court documents as needed.

• Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.

• Post payments in the electronic health record system and generate the appropriate member receipts.

• Greet members and sign in visitors of The Guidance Center.

• Reviews the schedule prior to appointments to ensure all members are screened for eligibility.

• Check in all scheduled members upon arrival.

• Manage Inter-RHBA transfers as appropriate.

• Upload confirmation spreadsheet daily for timely notification to members.

• Direct/transfer incoming phone calls to the appropriate department/staff.

• Follow appropriate check-in process to ensure 45-Minute Wait Time and One-Hour Transportation requirements are met.

• Monitor lobby to assure members needs and State requirements are met.

• Assist Central Scheduling with scheduling of member appointments.

• Assist with the completion and collection of Member Services survey data.

• Coordinate with other Member Services Representatives or Lead to ensure phone and lobby coverage at all times.

• Responsible for scheduling all TGC vehicles used by staff.

• Assist in training and mentoring new MSR's.

• Close all front office lobbies at close of business, securing all member information and money in locked drawers and cabinets.

• Provide assistance with AHCCCS applications or address changes as needed.

• Performs other duties as assigned.

GENERAL EXPECTATIONS

• Provide high quality customer service to internal and external customers.

• Must work well under pressure, meeting multiple and sometimes conflicting deadlines.

• Demonstrate cooperative behavior with colleagues and supervisors.

• Participate in Quality Improvement and Performance Improvement Processes of the agency.

• Complete all TGC required trainings on time.

• Maintains a high level of professionalism while performing job functions.

• Demonstrate flexibility and a willingness to learn.

• This position is 100% onsite/TGC campus, in the state of Arizona.

EDUCATION/EXPERIENCE

Required:

• High school diploma or GED equivalency.

• Related job experience deemed acceptable by HR.

• 2-4 years working with Microsoft Office.

• Proficient typing/keyboarding skills.

• Must be at least 18 years of age.

• Must be able to obtain and maintain an Arizona Level One Fingerprint Clearance Card.

Preferred:

• 2-4 years medical office experience or related education.

• 2-4 years' experience in a high-volume contact setting.

ACCOMMODATIONS

TGC will provide reasonable accommodations for individuals with disabilities unless it would cause undue hardship. We define reasonable accommodation as any change in the work environment or in the way a job is performed that enables a person with a disability to enjoy equal employment opportunities. We will make a good-faith effort to list any special requirements in our job descriptions.

The physical demands of this position warrant:

• Sedentary Work: Occasionally lifting 10 pounds or less, sitting most of the time and may involve walking or standing for brief periods of time.

CONFIDENTIALITY

Under Federal confidentiality laws, personnel of the Clinic may not disclose information about clients or personnel to anyone outside the Clinic without the person's prior written consent and may not disclose this information to others within the Clinic except on a "need to know basis". This includes any identifying information concerning current, past or prospective clients or personnel.