Description
Responsibilities
Member Service Representatives II-KSPA provide Concierge Service to members of the health plan which include providing a high level of service to callers and making outreach calls to members to provide information regarding health plan policies, obtain responses to various required surveys and promote member retention and growth initiatives. Member Service Representatives II-KSPA resolve inquiries from health plan members, providers, and various customers while consistently exceeding productivity, quality and service standards. Member Service Representatives II-KSPA have proven ability to quickly learn and put into practice software applications to respond to administrative issues related to health plan operations including claims resolution, premium billing, medical benefit interpretation, organization and coverage determinations, referral inquiries, Prescription Drug inquiries and enrollment/disenrollment activities. Member Service Representatives II-KSPA handles member and provider calls for our Medicare Advantage plan and have demonstrated ability to interpret Medicare Policy and Procedures including but not limited to Late enrollment penalty, low income subsidy, enrollment/disenrollment guidance, Medicare beneficiary protections and Medicare coverage rules. MSR II-KSPA will support KelseyCare Advantage chat conversations and make outbound calls to assist with scheduling member appointments and to determine disenrollment reasons..
Job Title: Member Services Representative II -KSPA
Location: Pearland Administrative Office
Department: Mem Provd Serv
Job Type: Full Time
Salary Range: $49,730 - $61,442 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Qualifications
Education
Required: High School diploma or GED from an accredited program
Preferred: Associates or bachelor?s Degree
Experience
Required: 5 years? experience in a health care or health plan insurance environment.
Knowledge of health Care and insurance and the ability to Interpret/Apply Medicare Prescription Drug
Benefits, Medical Benefit Interpretation, CMS Regulations, Texas Department of Insurance Regulations and
ERISA
Excellent interpersonal skills to interface with physicians and members of the health plan.
Strong ability to actively listen to customers, probe for clarification, and provide consultative guidance based
upon customers inquiries.
Proven Ability to use a variety of software applications and on-line resources
Excellent written communication skills
Analytical skills to evaluate problems and recommend alternative solutions
Preferred: Previous experience with a call documentation system
Knowledge of Medical Terminology
Ability to Work in a Fast Paced Continuously Changing Environment
Knowledge of CPT and ICD9 Codes
Ability to understand complex oral and written directions and technical information.
License(s)
Required: N/A
Preferred: N/A
Special Skills
Required: Strong knowledge of HMOPOS and TPA Plan Design and Claims Processing
Member Service Representatives must build and maintain productive
Preferred: EPIC? Tapestry Experience
Other
Required: Excellent communication and telephone etiquette
Problem-Solving and active listening skills
Representative III are required to pass knowledge testing and maintain positive Quality and Production Scores
Preferred: Fluency in Spanish
Working Environment: Office
About Us
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston?s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance
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