Member Support Specialist II - Medicare

PacificSource Health Plans - Portland, OR

Full-time - Entry Level

Portland, OR

Insurance Carriers and Related Activities

About the position

The Member Support Specialist II - Medicare at PacificSource Health Plans plays a crucial role in assisting members with complex psycho-social issues that hinder their healthcare journey. This position involves working closely with case management teams to develop tailored plans, educate members about their benefits, and connect them with community resources to enhance their health outcomes. The Specialist will engage with members both telephonically and in person, ensuring they navigate the healthcare system effectively and receive the support they need.

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 a variety of 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 help facilitate case management process.
• Participate in case management/care coordination meetings.
• Ensure compliance with applicable state and federal regulations and guidelines in day-to-day activities, including maintaining HIPAA standards and confidentiality of protected health information.
• Ensure accurate and timely documentation.
• 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.
• Assist care management to meet quality measures as outlined by government regulations.
• 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.
• Perform other duties as assigned.

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 and ability to work independently as well as 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.

Benefits

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