Member Services Representative, Sr. addresses more complex health plan or HMO member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls and written requests. Being a Member Services Representative, Sr. provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative, Sr. requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Member Services Representative, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
Registers patients based on multiple types of service, prioritizes registrations accordingly and engages in all necessary follow through. Obtains pertinent information from patient, determines insurance coverage and informs patients or their representatives of financial requirements, collecting when necessary according to hospital policy. |
Required: High School graduate or equivalent.
Preferred: Some college or technical training.
Experience:
Preferred: Hospital or similar medical facility experience.
Must be able to follow directions and to perform work according to department standards when no directions are given. Must be emotionally mature and able to function effectively under stress. Computer literate with spreadsheet and word processing applications. Organized, efficient and detail oriented. The ability to use Windows-based system, fax, copier, and multi-line, multi-function phone.
Licenses/Certificates: None
At Mountain View we pride ourselves on fostering an environment that is warm and welcoming where everyone feels heard, supported and valued. An environment that embodies a "family" culture that emphasizes not only the high standards in the care we deliver but also in the personal connections and relationships that form the heart of our institution. Our healthcare professionals and support staff work together as a close-knit family, united by a shared commitment to healing and improving the lives of our patients and each other.
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