Member Engagement Specialist - Part-time!

Advanced Health•Coos Bay, OR

1d•Onsite

About The Position

The Member Engagement Specialist serves as a primary point of contact for members while actively promoting engagement in health plan services and its available programs. This position combines traditional customer service functions with proactive outreach to improve member participation in preventive care, care coordination, health education, and other available benefits. The Member Engagement Specialist helps members understand and access covered services, resolve concerns, remove barriers to care, and connect with appropriate internal departments and community resources to support improved health outcomes and member satisfaction.

Requirements

Minimum High School Diploma or GED
Minimum two years’ experience in a medical office, clinic or healthcare administration setting
Minimum two years’ experience in customer service-related position
One to two years’ experience in public relations, community outreach, sales, or similar profession
Must reside in Oregon
Proficient in Microsoft Office Suite and Windows Operating System (OS)
Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
Excellent people skills and friendly demeanor
Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
Attention to detail and organization skills
Ability to handle stress and sensitive situations effectively while projecting a professional attitude
Ability to communicate professionally, both conversing and written
Ability to work with diverse populations and interact with people of differing personalities and backgrounds
Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
Ability to organize and work in a sensitive manner with people from other cultures
Poised; maintains composure and sense of purpose
Must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.
Constantly operates a computer or other office productivity machinery, such as postage machine, fax, copier, calculator, multi-line telephone system, scanner.
May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information.
Must be able to work under conditions of frequent interruption and be able to stay on task.

Nice To Haves

Associate degree in business administration preferred
THW Certification preferred, or willing to obtain
Bilingual preferred, qualified, certified, or willing to obtain
Knowledge of OHP program requirements, benefit package, eligibility categories, and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred
Knowledge of the Oregon Health Authorities Coordinated Care Organization required metrics
Understanding of basic concepts of managed care
Critical attention to detail for accuracy and timeliness
Ability to report to work as scheduled, and willingness to work a flexible schedule when needed

Responsibilities

Serve as the primary staff member responsible for proactive member engagement through outbound outreach to increase participation in preventive care, wellness programs, care coordination services, and other Coordinated Care Organization (CCO) initiatives.
Contact members by phone, text, mail, or other approved communication methods to educate members on available Medicaid benefits and CCO services, encourage completion of preventive health screenings, annual wellness visits, and immunizations, and promote member participation in health education, disease management, and care coordination programs.
Assist members in establishing or reconnecting with their Primary Care Provider (PCP).
Identify barriers to care and connect members with appropriate internal departments, providers, or community resources to improve access to services and health outcomes.
Document all outreach activities, member interactions, referrals, and outcomes accurately and timely within designated software systems.
Monitor assigned outreach campaigns and member engagement lists, prioritize outreach efforts, and maintain productivity and quality standards for engagement activities.
Serve as a member advocate by assisting members in navigating the healthcare system and coordinating with providers, care coordinators, and other departments to resolve concerns and improve the member experience.
Track outreach results and assist with reporting on member engagement activities, Health Risk Assessment completion rates, and other organizational quality initiatives.
Talk with members and providers by phone or in person, handling inquiries in a prompt, courteous manner.
Greet persons entering the building in a professional manner, determine nature and purpose of visit, and direct or call appropriate staff member to escort them to specific destinations.
Provide information to guests, members and the public, answer questions with discretion and tact.
Facilitate the resolution of complaints from customers, members, and/or the public, escalate to appropriate staff member(s) as necessary.
Act as a member advocate and liaison with providers and partners as needed to ensure members are connected to services.
Receive inquiries and route any issues to the appropriate person or department for resolution, responding in a timely manner and documenting the action taken.
Understand plan eligibility, benefit package and claims payment requirements.
Research, verify and resolve inquiries relating to Oregon Health Plan and Advanced Health eligibility.
Outreach members by phone to complete Health Risk Assessments.
Complete tracking and status reports.
Use current technology and software to document all activities from any mode of communication from members, providers and other customers.
Assist with the preparation and mailing of letters, notices, member handbooks, flyers, etc. as directed.
Receive and send packages.
Compose, type and edit correspondence, reports, memoranda and other material as assigned.
Ensure that the lobby is clean and kept free from clutter; report if windows, floors, walls, furniture, etc. need cleaning or repair.
Assist with other related clerical and administrative duties as assigned.
Participate in quality and organizational process improvement activities and teams when requested.
Ensure compliance with company policies and procedures as applicable to area(s) of responsibility.
Handle confidential information and materials appropriately and maintain a secure work area.
Participate in quality and organizational process improvement activities when requested.
Support and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities.
Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner.
Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization.
Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations.
Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications.
Advance personal knowledge base by pursuing continuing education to enhance professional competence.
Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards.
Represent organization at meetings and conferences as applicable.