Member Services Manager

Job Location:

Los Angeles, CA 90026

Reports to (title):

Healthcare Clinical Operations Director

Department:

Medical

Supervises:

N/A

Working title:

Program Manager

Classification:

Exempt

Salary Range:

G-09 ($30.25 - $45.38/hr.) (DOE)

Status:

Regular

Hours/Week:

40 hours

Effective Date:

March 18, 2024

Type of Position:

Full-time

Revised Date:

March 2024

Incumbent has the overall responsibility for medical records, registration, eligibility and appointment management for UAII. The MSM is responsible for ensuring the delivery of outstanding customer service, resolving issues and delivering accurate information to UAII members and providers. The MSM manages the day-to-day operations of member services ensuring the delivery of a high-quality patient experience. Works with clinical program directors and coordinators to ensure that front office procedures are efficient and align with clinical services.

• Oversees the day-to-day operations of the Member Services department; communicates all changes affecting UAII about managed care systems, health plan status, third-party reimbursement and any problems on a regular basis.
• Updates/creates registration and eligibility policies through supervisor, as necessary to ensure UAII policies and procedures are implemented equitably across the organization.
• Oversees the day-to-day operations for medical records functions, ensuring compliance with internal policies and accreditation standards in line with state and federal guidelines.
• Resolve staffing issues and facilitate conflict resolution for staff under direct supervision.
• Hire, discipline and terminate staff in coordination with the Human Resources department.
• Ensures effective communication between Billing and Registration, and clinical directors.
• Orients, trains, directly supervise and evaluate Member Services staff within Member Services Department. Ensures staff maintains excellent public relations with patients, clients, guests, and staff.
• Responsible for ensuring all registration and eligibility policies, procedures, guidelines, and criteria are followed.
• Proactively participates in and supports Member Services staff with the day-to-day functions of registration and eligibility.
• Provides training to member services staff regarding Medi-Cal, Medicare, managed care programs, private insurance health plan features, eligibility procedures and reimbursement requirements.
• Enforces HIPAA privacy laws and policies by department personnel and ensures timely training for all staff.
• Creates/edits events, categories, resources, and templates for the departments in the Electronic Practice Management system (EPM) appointment scheduler book and updates as needed.
• Assists in the coordination of provider/clinical schedules by applying provider schedule templates in the clinic EPM appointment scheduler book. Update provider blocks, Paid Time Off (PTO) and change in services within the EPM appointment scheduler.
• Monitors scheduling activities to ensure optimized productivity.
• Ensures managed care enrollment and marketing of UAII services by reviewing member data in insurance company portals and delegates staff to contact newly assigned members on a timely basis; assists in the development of welcome packets that introduce and educate new members on the services and programs offered at UAII.
• Ensures patient payment collections and procedures are followed, and cash deposits are reconciled and submitted to the Fiscal department on a timely basis.
• Responds to patient account discrepancies and reviews patient accounts to ensure accuracy of charges and services. Initiates and completes account corrections, patient refund request, and rebilling charges to correct payer sources.
• Assists in the quality assurance of member charts by reviewing patient demographics, payer sources, clinical coding, batching, and submits to billing department.
• Responds in a timely manner to Billing inquires; answers necessary treatment-related Billing questions and corrects as indicated.
• Runs and analyzes data reports to manage the functions of the Member Services department and operations of the UAII, such activities would be: maintain membership rolls, provider productivity, encounter status, No-show reports, and provide basic demographic statistics.
• Serves as liaison between UAII and Health Plan member service work groups regarding health plan problems, membership enrollment and disenrollment problems; attends training on new programs, customer service, and advocacy.
• Patient Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe patient practices.
• Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
• Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
• Works extremely well under pressure, meets multiple and often competing deadlines; and at all times demonstrates cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
• Actively participates in internal quality improvement teams to drive initiatives in accordance with the mission and strategic goals of the organization.
• Performs other job-related duties as assigned by supervisor.

• Must have knowledge about clinical treatment procedures and terminology.
• Knowledge of County Medical Services Program; Medicare; Medi-Cal; Healthy Families; State Office of Family Planning (SOFP); Presumptive Eligibility; and other state and local funding; grants/contracts and insurance carriers.
• Experience with electronic health record (EHR) systems, eClinicalWorks preferred.
• Significant experience with Microsoft Word, Excel, PowerPoint, Publisher and other applications.
• Ability to participate in and carry out planning and coordination of complex projects with task, timelines, exhibiting analytical and decision-making skills.
• Ability to meet deadlines and balance priorities with professional diplomacy and confidentiality.
• Ability to supervise in a union environment and delegate duties as required

• Prefer B.A. or B.S. degree in business administration or related field, or 5+ years of experience in For-Profit or Not-for-Profit management with significant administrative and budget responsibilities.
• An equivalent combination of education and experience sufficient to perform the essential functions of the position.

• A plus, but not required

• Maintain strict confidentiality of client and personnel information adhering to HIPPA, professional codes of conduct, State of CA regulations, Privacy Act, and UAII policies and procedures
• This position has access to sensitive information, and a breach in confidentiality will be grounds for disciplinary action up to and including immediate termination

• Possess the ability to communicate with others in a courteous and professional manner
• Excellent customer service skills
• Proficient in English

• Proficient in Microsoft Office Suite
• Ability to use Microsoft Teams and Zoom
• Comfortable navigating a fax, copy and scanning machine
• Able to type 30 wpm

• Available and willing to travel as needed
• Available to work evening and weekend hours as needed
• Willingness to learn new skills and participate in training sessions relevant to the position
• Must be a team player
• Must be able to work well in extremely fast-paced environments and in high- volume situations and be able to multi-task.
• Ability to work independently and exercise sound judgment and be able to make decisions appropriate to scope of authority and practice.

• Experience working with the American Indian/Alaskan Native community
• Experience working with nonprofit organizations, community groups, and performance-based government contracts.
• Knowledge of Indian Self-Determination and Education Assistance Act (Public Law 93-638)
• Fluent in both English and Spanish, both written and verbal

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.

UAII will make any practical, feasible, and reasonable arrangements to accommodate qualified applicants and employees with disabilities if it can do so without undue hardship.

In the performance of their respective tasks and duties, all employees of United American Involvement, Inc. (UAII) are expected to conform to the following:

• Uphold all principles of confidentiality and patient care to the fullest extent
• Meet or exceed the performance standards as set by your supervisor
• Interact in an honest, trustworthy, and dependable manner with clients, employees, and vendors
• Possess cultural awareness and sensitivity
• Adhere to all professional and ethical behavior standards as outlined in UAII's Employee Handbook
• Work independently and as a team member; consistently demonstrate professionalism, courtesy, efficiency, excellent internal and external customer service, high ethical standards, and behavior that contributes to harmonious relationships

EQUAL EMPLOYMENT OPPORTUNITY

United American Indian Involvement, Inc. (UAII) provides equal employment opportunities to all employees and applicants for employment. It prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

UAII abides by the mandates of the ADEA and the Fair Employment Housing and Housing Act (FEHA)-protecting individuals 40 years and older-and considers age a non-merit factor in all employment decisions and considerations.

UAII abides by the mandates of the ADA and FEHA and considers disability a non-merit factor in all employment decisions and considerations. Furthermore, UAII will make any practical, feasible, and reasonable arrangements to accommodate qualified applicants and employees with disabilities if it can do so without undue hardship. Applicants and employees may request accommodations for a disability at any time in the application process or during employment.

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.

• Eligibility to work in the US
• Fingerprint clearance
• Pass a post-offer drug test
• Negative TB test result (annual requirement)
• Prove of vaccination against the flu (annual requirement)
• Prove of full vaccination against COVID, including the latest Booster
• Valid CA driver's license
• Maintain auto insurance coverage