Member Services Assistant

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit http://www.amidacareny.org for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Member Services Assistant. Compensation will be commensurate with experience.

Position Summary:

The Member Services Assistant is responsible for documenting all phone call attempts to verify the member’s address for member returned mail. This role also handles the Quality Assurance of member letters, Re-mails, Termed Specialist, Service Verification, PCP Panel Transfers, Member Disenrollment, Provider Termination, Prospective member (Enrollment notification), welcome letters, New Member Orientation (NMO), RHIO, PCP Unknown, Call Center mailing, PCP auto-assignment and any Medicaid benefit change notification. The Member Services Assistant maintains/updates member demographic information. Conducts Outbound calls as specified below.

Responsibilities:

• Conducts outbound member calls to process returned mail to acquire correct addresses and member education on reporting demographic changes to HRA and/or the LDSS. All outbound call attempts must be documented on the member’s record.
• Conducts outbound member calls to verify member’s address based on address correction file provided by mailing vendor, Command, based on reported changes by the Post Office.
• Responsible for completing Quality Assurance (QA) for the following member letters: Re-mails, Termed Specialist, Service Verification, PCP Panel Transfers, Member Disenrollment, Provider Termination, Prospective member (Enrollment notification), welcome letters, New Member Orientation (NMO), RHIO, PCP Unknown, Call Center mailing, PCP auto-assignment and any Medicaid benefit change notification.
• Document RHIO consent on member record. Files and scans all Member Services member records (i.e. RHIO forms).
• Responsible for processing and the submission for Plan Initiated Disenrollment's (PIDs) to HRA and Maximus.
• Ensure member confidentiality and adhere to Confidentiality and HIPAA policies and regulations.
• Data entry tasks as needed.
• Responds to chart requests from other departments and audits to ensure completeness. Send digital files where possible and retains the physical file for accountability.
• Update all invalid member demographics.
• Mail new member IDs as requested.
• Perform other duties as assigned by the Assistant Director Member Service Operations and Member Experience leadership team as necessary.
• Document and file all returned mail in database.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

EDUCATION REQUIRED

• High School Diploma or GED.

EXPERIENCES AND/OR SKILLS REQUIRED

• Knowledge of Microsoft word, excel and mail merge functions, Salesforce.
• Prior experience in medical record management a plus.
• Prior experience in document scanning and digital archiving preferred.
• Previous experience in a managed care environment, a physician office or other clinic setting preferred.
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.