SUMMARY OF JOB DUTIES:
The Member Support Specialist (MSS) directly engages and assists the Member Support Representative (MSR) within the assigned center(s).
The MSS role will act as an extension of the MSR internally and externally when necessary.
ESSENTIAL JOB FUNCTIONS:
Identifies internal members, relations to work cohesively with MSR for conversion into HMO through Point of Care Opportunities
Age-In Report
Handwrites Birthday Cards
Obtains signatures from MSR/MSS, PM and Care Team
Include MSR/MSS Business Card
Traditional Medicare Appointment Lists
(Reviews and omits Tricare/ChampVa/Retirement Plans)
Leads from Events/Marketing
Schedule Tours, conducts Tours if MSR off-site
Schedule New Patient & Annual Wellness Visits (AWV) Appointments
Updates the "Leads" tab on the MSR Master Spreadsheet (MS Excel)
Updates MSR Master Spreadsheet if patient selects a Value-Based Medicare Plan
Mailout Campaigns (schedule tours/first appointments)
Member Issues
Primary Care Physician (PCP) Assignments
Transportation
Patient Assistance Programs (PAP)
Reminders & Notifications
Creates Slybroadcast for various conversion list opportunities
Contacts each Medicaid-Medicare personally
Obtain Consent To Contact (CTC)
Contact Broker/Agent
Follow-up with Broker/Agent
Updates MSR Master Spreadsheet ("leads" tab) and Athena medical records system
The MSS engages with new patients after MSR has scheduled first appointment through and beyond for retention
The MSS manages, upkeeps the Athena system and associated rosters/spreadsheets with new leads and contacts assigned to MSR
Enter New VBC Patients and New Medicare Patients including scheduling New Patient Appointment and Annual Wellness Appointment
Change insurance in EMR system from non-VBC Plan to VBC Plan
Create Patient Cases when necessary (Rx refills, clinical questions, referral questions, etc)
Inactivate Deceased and Inactive Patients in EMR system (includes PCP changes, move out of area status)
Report Building/Library (ties into those turning 65(T65) and Medicaid/Medicare) as requested/needed by MSR
The MSS engages with new patients after MSR has scheduled first appointment through and beyond for retention
Answers phones, follow-up on Voicemails
Meets with patients in office to conduct:
Complete Health 360 assessment
Patient Assistance Program (PAP) reviews
Annual renewal of PAPs
The MSS works in partnership with he MSR to obtain a team Medicare Advantage enrollment goal per their center(s) assigned
The MSS ideally spends 90% of their time within their office(s), 10% assisting with events/outreach led by MSR
Requirements:
MINIMUM REQUIREMENTS
Service-excellence oriented in a healthcare setting (e.
g.
, senior diabetic, dental offices, primary care, etc.
) or health-plan support of Medicare Advantage to doctors' offices and staff;
Knowledge of various Medicare plans, including Medicare Advantage HMO, PPO, C-SNP, D-SNP;
Demonstrated experience on member roster reconciliation, preferably in MS Excel;
Outreach via email, chat, phone, & written correspondence;
Experience supporting member events on & off-site, including occasional evening & weekend hours;
Ability to give tours and guide members to services both within the clinic and within the member's health-plan, as well as outside agencies.
WORKING ENVIRONMENT
The position requires climbing, stooping, kneeling, crouching, reaching, standing, lifting, grasping, feeling, talking, hearing, repetitive motions, and finger use.
Pushing and pulling are occasionally required.
Use of a computer, keyboard, and telephone along with various office machines is an essential part of the job.
DISCLAIMER
The above statements are intended to describe the general nature and level of work being performed by the Member Support Specialist.
They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
The Member Support Specialist may be required to perform duties outside of their normal responsibilities from time to time as needed or as directed by supervision.
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