Under limited supervision to respond in a timely, accurate and courteous manner to the inquiries and concerns of the health plan members and the general public. The VHP Member Services Representative is the primary liaison between the health plan member, network providers and the health plan.
- Answers phone; screens and refers callers;
- Provides members and providers with information about the VHP network, health plan options and benefits;
- Educates members about proper use of the health plan;
- Assists members with benefit interpretation registration, and new enrollment;
- Serves as liaison or advocate between the member and network providers or other departments within VHP;
- Assists with the management of complaints and grievances in accordance with the policies and procedures;
- Identifies, addresses and documents member/provider issues and trends in order to achieve member satisfaction;
- Maintains and reports information on members and services as required;
- Maintains, organizes and updates member related files;
- Assists in conducting member satisfaction surveys and reports;
- Types a wide variety of forms, documents and correspondence using computer programs;
- Initiates and composes letters, and memos;
- Reconciles and corrects discrepancies payment for groups that VHP provides coverage to;
- Maintains proper inventory of handbooks and manuals;
- Performs other related duties as required.
Demonstrated education, training and experience performing admitting functions in a medical setting, which has provided an opportunity to acquire the following knowledge and abilities:
A candidate would normally acquire the knowledge and abilities listed below by attaining two (2) years of work experience as a Health Services Representative, medical receptionist or Customer Services Representative in a managed care or health maintenance organization.
- Basic medical office practices and procedures;
- Interviewing techniques and telephone etiquette;
- Basic medical terminology;
- Medical billing;
- Proper English usage, style grammar, punctuation and spelling;
- Medi-Cal Managed Care protocols;
- General policy of health coverage limits related to managed care and HMO standards;
- Purpose and use of International Classification of Disease Standards;
- Purpose and use of the Concurrent Procedure Terminology;
- Computer and software usage including use of databases and word processing programs.
- Perform a variety of clerical duties and work effectively under stressful conditions;
- Type with moderate speed and accuracy;
- Organize and manage detail effectively;
- Work with a culturally diverse patient population;
- Work independently, establish work priorities and meet deadlines;
- Utilize effective interpersonal and problem-solving skills;
- Use a keyboard with moderate speed and accuracy.