Member Services Rep

Job Description:

Overview

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.

Responsibilities

This position interacts with patients, health insurance companies, as well as physicians and their staff to address questions concerning member eligibility and benefits, Primary Care Physician (PCP) assignments, Managed Care authorizations, and Out of Group claims.

Qualifications

Minimum Qualifications:

- One (1) year of related experience (i.e. office experience, insurance services, customer service, etc.)
- High School diploma required or GED.
- Effective communication skills both orally and in writing.
- Demonstrated skill in working with a wide range of customers while maintaining accurate system documentation. Excellent interpersonal and customer service skills.
- Ability to navigate and utilize information system, as well as PC based computer software (e.g. Microsoft Windows, Work and Outlook).

Preferred Qualifications:

- One (1) year of related experience in the Healthcare Industry preferred.

- Experience with claims or invoice process (adjudication) is strongly preferred.

- Knowledge and understanding of how HMO/Managed Care works preferred
- Experience in obtaining, interpreting, and building HMO member benefits using the information provided by the Health Plans preferred.
- Experience, or a good understanding of Member Out of Pocket Max (MOOP) and Member Deductible preferred.
- Experience or a good understanding Division of Financial Responsibility (DOFR) preferred

Please note: This position will be work from home in the Greater Sacramento region once the initial onsite onboarding and training has completed.