Member Services Representative

POSITION SUMMARY

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

ESSENTIAL FUNCTIONS

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

2.  Explains all required forms to the patient or guarantor and obtains the necessary signatures.

3.  Ensures medical necessity compliance by obtaining necessary data, communicating information to patient or guarantor and obtaining necessary signatures.

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

5.  Collects and copies client ID, Social Security cards (if child, SS cards for both parent/guardian & child), Insurance card (front & back), Birth Certificate (for children).

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

7.  Posts payments in the computer system and generates the appropriate patient receipts.

8.  Provides financial counseling for all outstanding patient balances.

9.  Act as receptionist greeting consumers/public.

10.  Greet and sign in visitors of The Guidance Center.

11.  Reviews the schedule prior to appointments to ensure all non-AHCCCS clients are screened for eligibility

12.  Notify physicians, medical specialists or clinicians of consumer arrivals.

13.  Correctly enter InterRHBA tranfers.

14.  Complete consumer confirmation calls.

15.  Ensures access to all TGC buildings is compliant and safe according to TGC?s procedures.

16.  Assist consumers and staff by directing/transferring phone calls to the correct staff.

17.  Make confirmation calls to scheduled consumers or as requested by clinicians.

18.  Maintain State required logs for 45-Minute Wait Time and One-Hour Transportation.

19.  Monitor lobby to assure consumer needs and State requirements are met.

20.  Schedule consumer appointments.

21.  Maintain supplies as needed for office and lobby.

22.  Assist with the completion and collection of customer service survey data.

23.  Coordinate with other Patient Access Representatives to provide phone and lobby coverage.

24.  Responsible for check in/out process for vehicles and laptops used by staff.

25.  Assist in training new employees, mentoring new reception staff.

26.  Provide high quality service to internal and external clients.

27.  Must work well under pressure, meeting multiple and sometimes conflicting deadlines. The employee shall, at all times, demonstrate cooperative behavior with colleagues and supervisors.

28.  Shut down front desk at end of shift, securing all client data in locked drawers and cabinets to maintain confidentiality.

29.  Special projects as assigned and other minor office duties as assigned by supervisor.

30.  Complete all TGC required training.

31.  Participate in the Quality Improvement Processes in the agency.

32.  Willingness to learn.

33.  Other duties as assigned.

KNOWLEDGE/SKILLS/ABILITIES

Required:

  • High school diploma or GED equivalency
  • 2-4 years working with Microsoft Office
  • Proficient typing/keyboarding skills
  • Age 18 or older
  • 2-4 years Medical office experience or related education
  • 2-4 years experience in a high volume contact setting.
  • Ability to obtain Arizona Fingerprint Clearance Card

Accommodation(s)

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 up to 10 pounds. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. I have reviewed and received a copy of this Job Description.  I understand my job responsibilities and performance expectations/standards.  I further understand that I may be responsible for other activities not listed in this document.

I have reviewed and received a copy of this Job Description.  I understand my job responsibilities and performance expectations/standards.  I further understand that I may be responsible for other activities not listed in this document.

CONFIDENTIALITY LEVEL:  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.