Member Services Rep
Member Services RepRequisition #: 427693Location: Johns Hopkins Health Care, Hanover, MD 21076Category: Non-Clinical ProfessionalWork Shift: Day ShiftWork Week: Full TimeWeekend Work Required: NoDate Posted: Oct. 14, 2021Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.Position Summary:These positions provide support for Priority Partners growth, compliance, member education, and retention efforts, reporting to the Member Services Supervisor. Responds to telephone, email, and mail inquiries from members and potential members, and is focused on supporting members in obtaining medical treatment and preventative health care services. Outreaches new members to provide education and full understanding of benefits, supplement existing member data, and obtain information pertaining to medical/social issues that need immediate and/or focused intervention. Refers members to care management, health education, special needs, and/or quality improvement departments as appropriate, Arranges transportation as needed. Has responsibility for all fulfillment efforts triggered through advertising and marketing campaigns. Assists members in redetermination efforts. Tracks and documents all interactions.Task requirements for position:Handles all potential members' inquiries resulting from advertising & marketing efforts per department policies and procedures.Provides welcome and orientation for new membersAssesses members' health and social risk factors and refers members for appropriate care plans and interventions. Assist members with overcoming barriers in accessing healthcare appointments and to bring non-adherent members into care.Responsible for getting enrollees in care. Manages member case load effectively according to COMAR regulations and JHHC processes.Maintains relationship with members. Provides members with appropriate JHHC and community resources.Assists members with accessing care; assists members with barriers regarding transportation; assists members with barrier regarding language/interpretation.Makes appropriate referrals to case management, social work, behavioral health, and health education staffAssists members with redetermination effortsStandards for Production and Quality, Reporting, Administrative DutiesEducation:Requires High School diploma or equivalent. Associates degree related to advocacy, health care, or community relations preferred.Knowledge:Requires basic knowledge of social and health issues to effectively determine appropriate educational and service support.Requires familiarity with the personal experiences of families with low/moderate income.Requires a working knowledge of local, state, and federal family support resources.Familiarity with medical terminology, ICD-9/10 and CPT codes beneficial.Knowledge of DHMH eligibility and redetermination requirements.Requires experience engaging and working with community stakeholders.Requires experience as an advocate for groups or persons that are underserved.Skills:Requires excellent interpersonal and communication skills to effectively deal with diverse groups of community members.Requires strong problem solving skills to effectively assess social/health needs of members and arrange for appropriate services required to meet those needs.Requires basic level of customer service responsiveness with telephonic experience.Requires excellent organizational skills, flexibility, and the ability to get things done.Must be compassionate and sensitive to diverse situations.Must be able to enter data into a computerWork Experience:A minimum of one year experience in social, community, managed care, health care, or medical office related field.Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.