Member Service Specialist

Member Services RepresentativeEffectively manage member needs and benefits by providing answers to patient questions, process claim adjudication, and manage plan enrollments. Maintain provider relations by creating authorization numbers, complete provider credentialing, maintain contracts, and location updates.Duties and Responsibilities:Answer Member Services queue line in a timely manner. Assist patients with eligibility, benefits, locating stores, and resolving problemsMaintain all providers on CAQH and Gemini for credentialing. Update provider information in software, on directory, and on website. Follow up with providers regarding missing information, record due, and completion of credentialingReview and research upload errors from retail location. EDI claim through TriZetto. Complete rejection letters and maintain rejection log. Partner with providers to resolve claim errorsMaintain contracts with groups and brokersProcess end of month payout. Review all claims for accuracy, generate appropriate reports, submit affiliate and referral claims to Accounts Payable department for payment. Generate group rate reports and send to Accounts Receivable department for invoicing.Respond to and troubleshoot with other departments and stores regarding claim and authorization errorsProcess remakes, benefit reinstatements, and commission paymentsMaintain store programs and support (agent on record)Develop and maintain standard and shelf pricingDevelop and maintain sales collateralsProgram developmentMaintain strategic partnershipsDevelop and maintain ancillary programs (safety, school grants, etc.)Assist with health fairs offsite as neededMinimum Knowledge, Experience & Skills Requirements:High School Diploma or equivalentVocational or Technical training Field of Study: CPC, CBCS, RHIT or similarAssociate degree or bachelor's degree in business administration, management, communication or related fieldCombination of education and/or equivalent work experience in a related fieldKnowledge of billing, coding, credentialing, and HIPPA a plus1-3 years of progressively responsible experience in member services field0-1 years of supervisory experienceFocused, customer-centric mindsetExcellent communication and interpersonal skills, with the ability to build relationshipsExceptional organizational and time management skills, with the capacity to prioritize and manage multiple tasks simultaneouslyStrong problem solving and critical thinking skillsFlexibility and adaptability to work in a fast-paced, dynamic environmentProficiency with MS Office Suite of programsEssential Functions & Work Requirements:Ability to effectively communicate at all levels within the organization through written and two-way verbal communicationAble to sit or stand for extended periods of timeAble to operate various office equipment (e.g., personal computer, telephone, fax machine, copier, etc.)Able to read and write at a high school graduate levelAble to lift 10 to 20 poundsAble to work normal and/or extended (evenings, nights, and weekends) office hours to meet established deadlinesAble to travel independently to support Company objectives and personal developmentThese statements are intended to describe the general nature and level of work performed by teammates assigned to this job classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required.