Member Services Specialist
1 day ago
Los Angeles
Job DescriptionDescription: United American Indian Involvement (UAII) is the only Urban Indian Organization in Los Angeles County, proudly serving as a home for American Indian and Alaska Native communities. Through our healthcare facility and culturally centered programs, we provide essential physical, behavioral, and spiritual health services—helping individuals stay connected to their Tribal heritage and traditions. For over 50 years, UAII has grown to become the largest nonprofit provider of health and human services for American Indians and Alaska Natives in Los Angeles, home to the nation’s largest Urban Indian population. Our dedicated team delivers compassionate care that supports daily healing, resilience, and the continued strength of our communities. UAII is committed to uphold Indigenous values in all aspects of our work. It guides our actions, relationships, and responsibilities, ensuring that we serve our communities with integrity, respect, and accountability. Core Principles • Respect for Relatives – I will honor the dignity of all people, recognizing that every individual is a relative deserving of respect, compassion, and care., • Community Responsibility – My work is not only for individual benefit but for the collective well-being of our communities, present and future., • Cultural Integrity - I will safeguard and uplift Indigenous languages, traditions, and cultural practices, ensuring they remain central to our organizational life., • Reciprocity - We give back in balance with what we receive, fostering mutual trust and accountability in all relationships., • Stewardship – I will act as a caretaker of our communities, resources, and environment, mindful of the impact of our decisions on future generations. The Member Services Specialist (MSS) works as a part of a multi-disciplinary team of individuals who provide high quality member care. The MSS must be able to accept and adhere to guidance and direction from multiple levels of management. The MSS will work with members to identify appropriate funding sources that may cover the cost of treatments and determine fees and co-payments as appropriate. This position requires knowledge of clinical terminology and treatments and is responsible for assisting members with accessing services at UAII. Job Duties & Responsibilities · Greet all members in a courteous and professional manner to create and maintain a welcoming atmosphere. · Schedule member appointments appropriately, answer and return telephone calls in a timely manner, and inform members of processes and procedures. · Proactively manage and “triage” appointment scheduling to maximize productivity and to fill appointment gaps. · Manage the voicemail system – which includes creating and updating greetings as appropriate; checking messages often and ensure messages are routed appropriately and activating the voice message system at appropriate times. · Make member appointment reminder calls the day prior to confirm appointment and notify members of any outstanding balances on their accounts. · Answer member inquiries about; financial responsibility, insurance and benefits, account status, and treatment planning. · Receive and deliver messages to providers, ensure all stakeholders are aware of schedule changes, distribute member appointment schedules daily, prepare charts/documents, and inform the provider of outstanding payments that pertain to services requiring payment i.e. Dental Labs. · Register members into the practice management system (PMS) in a manner that ensures accuracy and thoroughness and update member registration information once per year at minimum, or as information changes. Inform members of Notice of Privacy Practices and obtain the members signed acknowledgement statement. · Register members into UAII member portal. Provide user support and education on portal functionality. · Manage UAII member portal appointment request and member messages. · Screen members’ eligibility for possible care coverage (e.g., county or state programs; sliding scale.) Inform members of program limitations and ensure member understands the information being conveyed. · Responsible for entering accurate assigned payer codes in PMS, entering expiration dates according to guidelines, terminating inactive payer codes, and select appropriate payers' codes for services. · Follow UAII procedures when collecting payments from members and issue a receipt every time. Inform appropriate staff of payment status. · Confirm member insurance eligibility on all scheduled appointments at least two days prior to scheduled appointments. Notify members in a timely manner of changes to insurance benefits. · Coordinate Private Insurance benefits with the member and the provider by; verifying coverage/benefits, limitations, waiting periods, pre-authorizations, and financial responsibility. · Check-in members for their scheduled appointments in a timely manner and complete all flows for the member appointment such as verifying member demographics, processing payments, insurance verifications, payer code selection, printing encounter labels, and pulling charts as appropriate. · Create and review member account alerts and flags for account status, identifying programs, service locations, treatment related notations, banned member status, etc. · Document members contact by telephone, in person, by mail as appropriate in electronic health record. · Log and reply promptly to health record requests for chart notes, radiograph copies, lab results and ensure they comply with HIPAA policies and procedures. · Respond promptly to Billing inquiries; answer necessary treatment-related Billing questions and correct as indicated. · Assist in the quality assurance and timely submission of encounter forms, as requested. · Assist with language translation as needed for healthcare services. · Actively participate in internal quality improvement teams to drive initiatives in accordance with the organization's mission and strategic goals. · May participate on weekend and after-hour events and clinics, as assigned by Supervisor. · MSS’s are assigned appropriate duties as it relates to specific sites, programs, and departments. These duties may include data entry, maintaining logs, generating reports, invoicing for payments and grants, ordering supplies, scheduling pick-ups and deliveries, maintaining active/inactive charts, sort mail, attend meetings, assisting in audits, and supporting satellite clinics. · Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices. · Work well under pressure, meet multiple and often competing deadlines. · At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community Requirements: Minimum Qualifications (Education & Experience) · Associate degree in Social Work, Family Development, Human Services, or related field. · Two (2) years of experience working as a medical or dental receptionist or registrar. · BLS/CPR Certification; must be obtained within 90 days of employment. · A combination of experience, education, and training may substitute for degree requirements on a year for year basis. Preferred Qualifications (Education & Experience) · Bachelor’s degree in Social Work, Family Development, Human Services, or related field. · Three (3) years of experience working as a medical or dental receptionist or registrar. · Experience working with the American Indian/Alaskan Native community. · Experience working with nonprofit organizations, community groups, and performance-based government contracts. . Spanish language skills strongly preferred due to regular interaction with Spanish-speaking clients/customers. Knowledge, Skills, and Abilities · Knowledge of private insurance eligibility and benefits and various state and county funding sources is desired. · Experience using an electronic health/dental record system and practice management system is desired. · Knowledgeable in clinical treatment procedures and terminology. · Knowledge of private insurance eligibility and benefits and various state and county funding sources is desired. · Knowledge and understanding of Indian Child Welfare Act and/or related laws and programs that impact American Indian children, families and adults. · Knowledge of Indian Self-Determination and Education Assistance Act (PL93-638). · Knowledge of Title V of the Indian Health Care Improvement Act (PL 94-437). · Knowledge of the Affordable Care Act (PL 111-148). · Strong understanding and sensitivity to American Indian/Alaska Native (AI/AN) cultures and lifestyles, and work effectively with AI/AN population. · Effective oral and written communications skills with sensitivity to lifestyles of targeted participants. · Skills in operating personal computer using a variety of computer software (Microsoft Office, Adobe, Microsoft Teams, Zoom). · Ability to maintain strict confidentiality of client and personnel information and comply with all applicable federal and state privacy laws, as well as UAII policy (HIPAA, HITECH, etc.). · Ability to establish and maintain cooperative working relationships with management, coworkers, and outside contacts. · Ability to keep up with a fast-paced environment. · Ability to learn and apply program/agency operating policies and procedures. · Ability to manage multiple priorities and tasks concurrently and meet deadlines. · Ability to interact with various people on various, and at times, complex issues. · Ability to work independently as well as with teams. Conditions of Hire · Eligibility to work in the U.S. · Fingerprint clearance and post-offer drug test. · Proof of hepatitis B vaccination and TB screening. · UAII strongly encourages COVID-19 and Influenza vaccinations; in the absence of the recommended vaccinations, employees are required to wear a mask while on company premises. Benefits · Medical, Dental, and Vision Coverage · Voluntary Accident, Critical Illness, and Hospital Indemnity Insurance Plans · Company-paid Short-Term & Long-Term Disability · Company-paid Basic Life Insurance and AD&D · HSA, FSA · 403(b) Retirement Plan with 4% Employer Match · Employee Assistance Program · Bereavement and Jury Duty Paid Leave · Employee Wellness Program · Paid Vacation - 12 days (first 2 years) Working Conditions The work environment characteristics described here represent those employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stand and/or sit. The employee is occasionally required to walk, sit and climb or balance. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, peripheral vision and depth perception. United American Indian Involvement, Inc. (UAII) provides equal employment opportunities (EEO) to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to any protected status under federal, state, or local law. UAII is a drug-free workplace and complies with ADA regulations. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. UAII is committed to providing reasonable accommodations for qualified individuals with disabilities and for sincerely held religious beliefs, in accordance with applicable law.