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PacificSource Health Plans - Salem, OR
posted 3 months ago
About the position
The Member Support Specialist II - Medicaid at PacificSource plays a crucial role in assisting members with complex psycho-social issues that hinder their healthcare journey. This position involves working closely with case managers to develop tailored plans, educate members about their benefits, and connect them with community resources. The Specialist will also participate in program development and foster strong relationships with both members and providers to enhance health outcomes.
Responsibilities
- Develop and implement goals and/or plans to assist members in navigating the healthcare system.
- Educate members on understanding their benefit structure.
- Utilize motivational interviewing and patient-engagement techniques to support members.
- Identify community resources and make appropriate referrals to members.
- Serve as a liaison between members and providers/agencies.
- Identify members for coordination and case management services using claims data and reports.
- Screen requests for appropriate referrals to case management.
- Collaborate with the case management team to facilitate the case management process.
- Ensure compliance with state and federal regulations, including HIPAA standards.
- Assist members with referrals, scheduling appointments, and transportation to medical appointments.
- Manage mailing lists and outgoing mailings.
- Assist with departmental procedures, reports, and projects.
- Enter and collate data; prepare reports as assigned.
- Participate in team, department, company, and community-related committees.
- Make presentations to small groups and participate in quality improvement initiatives.
Requirements
- A minimum of three years of experience in community services or healthcare agencies focused on coordination services required.
- High school diploma or equivalent required.
- Knowledge of medical terminology.
- Proficient in Microsoft Office, including Word, Excel, PowerPoint, and medical management software (e.g., CaseTrakker Dynamo).
- Excellent verbal and written communication skills.
- Ability to work independently and effectively on a team.
- Good working knowledge of community resources and the healthcare system.
Nice-to-haves
- Experience in health insurance and delivering group presentations preferred.
Benefits
- Flexible telecommute policy
- Medical, vision, and dental insurance
- Incentive program
- Paid time off and holidays
- 401(k) plan
- Volunteer opportunities
- Tuition reimbursement and training
- Life insurance
- Flexible spending account options
