Member Support Specialist II - Medicare

PacificSource Health Plans - Malta, MT

Full-time

Malta, MT

Insurance Carriers and Related Activities

About the position

The Member Support Specialist II - Medicare at PacificSource plays a crucial role in assisting members with complex psycho-social issues that hinder their adherence to medical regimens and optimal health outcomes. This position involves working closely with case managers to develop tailored goals and plans, educating members about their benefits, and facilitating access to community resources. The Specialist will also engage in program development and foster strong relationships with both members and providers.

Responsibilities

• Develop and implement goals and/or plans tailored to assist members in navigating the complexities of the healthcare system.
• Educate members on understanding and working within the parameters of their benefit structure.
• Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes.
• Identify community resources and make referrals to members as appropriate.
• Serve as liaison between members and providers/agencies.
• Identify members for coordination and case management services through various methods, including claims data and reports.
• Screen requests to identify appropriate referrals to case management from multiple internal and external sources.
• Work collaboratively with the case management team to facilitate the case management process and participate in related meetings.
• Ensure compliance with applicable state and federal regulations and guidelines, including maintaining HIPAA standards and confidentiality.
• Assist members with referrals, scheduling appointments, and ensuring transportation to medical appointments is available.
• Assist members with non-clinical needs for transitions and different phases of care.
• Manage mailing lists and outgoing mailings.
• Assist with the development of departmental procedures, reports, and projects.
• Enter and collate data; prepare reports as assigned.
• Participate in team, department, company, and community-related committees as requested.
• Make presentations to small groups and actively participate in quality improvement initiatives.
• Meet department and company performance and attendance expectations.
• Perform other duties as assigned.

Requirements

• A minimum of three years of experience in community services or healthcare agencies focused on coordination services required.
• Experience in health insurance and delivering group presentations preferred.
• 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, able to work independently and effectively on a team.
• Good working knowledge of how to access community resources and the healthcare system.

Nice-to-haves

• Experience in health insurance and delivering group presentations preferred.