Member Support Specialist II - Medicare

PacificSource Health Plans - Springfield, OR

Full-time - Entry Level

Springfield, OR

Insurance Carriers and Related Activities

About the position

The Member Support Specialist II - Medicare plays a crucial role in assisting members with complex psycho-social issues that hinder their healthcare adherence and optimal health outcomes. This position involves working closely with case management teams to develop tailored goals and 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.

Responsibilities

• Develop and implement goals and/or plans tailored to assist members in navigating the healthcare system.
• Educate members on understanding and working within their benefit structure.
• Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes.
• 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 through various methods, including claims data and reports.
• Screen requests to identify appropriate referrals to case management from multiple sources.
• Collaborate with the case management team to facilitate the case management process.
• Participate in case management/care coordination meetings.
• Ensure compliance with state and federal regulations and maintain HIPAA standards.
• Ensure accurate and timely documentation of member interactions and services.
• Assist members with referrals, scheduling appointments, and transportation to medical appointments.
• 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.
• Actively participate in quality improvement initiatives.
• Meet department and company performance and attendance expectations.

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 as part of 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.

Benefits

• Health insurance coverage
• 401k retirement savings plan
• Paid holidays
• Flexible scheduling options
• Professional development opportunities