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Clinical Member Services Representative (part time) in Wixom, MI at Beacon Health Options

Date Posted: 12/2/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic, part time Clinical Member Service Representative to join our team in Wixom, MI! The Member Services Representative is responsible to answer subscriber and provider questions about benefits, eligibility, claims and certification.  Ensure customer satisfaction and promote a positive corporate public image.  Screen incoming subscriber and provider calls/inquiries and take data to initiate cases.  Quote accurate benefit and policy information regarding inpatient and alternative levels of care. Handle complicated inquires and educate providers/subscribers in the certification process and reconcile inconsistencies and procedural difficulties when necessary Perform all data entry for case initiation and update and enter data into system for non-participating providers.  Special projects and all other duties as assigned.

Shift: 11:00 a.m. - 3:30 p.m., Monday - Friday

Position Responsibilities:

  • Perform responsibilities and tasks in ways that promote good will, build positive relationships, preserve human dignity and contribute positively to the corporation service orientation.  Service calls in a professional and courteous manner. Perform review of service requests for completeness of information.
  • Answer telephone calls identifying those needing case management services, those needing referral to routine outpatient services, and those needing authorization and/or verification.  Answer questions from providers, members, insurance carriers and/or Beacon regional offices. Certify benefits per account specific guidelines.  Provide list of in-network providers to callers.  Explain benefits and benefit maximums that have been reached. Verifies benefits against contract requirements prior to case initiation.  Refers complicated cases to Case Managers.  Collect and transfer non-clinical data.  Acquire structured clinical data.  Perform activities that do not require evaluation or interpretation of clinical data. 
  • Attend all staff meetings, team conferences and in-service as directed.  Comply with all credentialing and other PSO requirements.  Assist to train new unit personal and to set up new clinical case management units as directed.  Assist in special projects as directed by the Department Manager/Supervisor.  Assist clinical area managers to prepare for re-authorization of services by gathering necessary information and retrieving relevant subscriber files.  Assist to maintain subscribers’ files.  Assist Clinical Case Managers to complete claims investigations and facilities claims payment by verifying authorizations, verifying member eligibility and researching provider information.
  • Record complaints, grievances and appeals.
  • Collects demographic data from providers/subscribers for case initiation.  Completes data entry for authorizations.  Perform data entry for case initiation and updates.  Research and investigate claims inquiries.  Document all inquiries.
  • Apply Beacon policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards.  Meet Departmental expectations, accuracy, productivity, and performance standards. Support Beacon in achieving Mission Statement.  Adhere to the components of the Compliance Program.  Ensure that job tasks are performed in a legal and ethical manner.  Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline.  Adhere to compliance training requirements and understand that training is required condition of employment.   Complete tasks accurately and within required timeframes.

Position Requirements:

  • Education:  Bachelors’ degree in Social Work, Psychology or equivalent in a related health care field required
  • Relevant Work Experience: 1 year of customer service experience or experience in the behavioral health care field required
  • Knowledge, Skills, & Abilities:
    • Strong customer service and written/verbal communication skills required
    • Ability to quickly summarize telephone conversations and accurately input to a computer
    • Ability to maintain a professional demeanor during a crisis situation
    • Excellent time management and organizational skills

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled