Member Services Concierge

Personify Health • Covington, LA

22h • Onsite

About The Position

As a Member Services Concierge, you will serve as a member or family’s single point of contact at Personify Health for any questions or concerns they may have regarding bills they have received. Members enrolled in the Personal Assistant program will bypass the call center and calls come directly to the Member Services Concierge assigned to that particular member and/or family. You will assist members and their family when there is a serious event or catastrophic illness, helping them navigate multiple bills and determine responsibility. The Member Services Concierge role helps alleviate the administrative burden associated with serious diagnoses/illnesses, providing relief for families and allowing them to focus on their health and treatment. Candidates are identified through a daily pre-cert download, working off a trigger diagnosis pre-cert list. The Personal Assistant team proactively reaches out to these members with an introductory phone call and welcome letter, including the concierge's business card and direct contact information. Referrals may also come from clients and broker partners for employees or families struggling with changes who would benefit from a single point of contact. You may also assist clients by requesting a stat review of an urgent pre-cert request and ensuring members are assigned a Case Manager. Member Services Concierge agents are administrative, while Case Managers are medical (R.N.).

Requirements

• Excellent communication skills
• Interpersonal skills
• Time Management skills
• Strong organizational skills
• Ability to multitask
• Attention to detail
• Show Empathy
• Active Listener

Nice To Haves

• 3+ years in Member Services Call Center highly recommended

Responsibilities

• Answer questions about coverage under the healthcare plan
• Review claims for discrepancies or duplications
• Obtain information needed to process outstanding/pending claims
• Explain benefit payments and true patient balance due if any after medical benefits have been paid
• Work with provider billing departments to prevent balance due statements and collections
• Find providers that participate with the healthcare plan
• Coordination of coverage if there is coverage under another insurance plan
• Lend an ear and offer words of encouragement during challenges of personal illness or caring of a sick loved one
• Work with Case Manager's to ensure that Pre-Cert is in place for various treatments, i.e. clinical trials, surgery, chemotherapy etc.
• Assist in ensuring that the provider sends in Clinicals for review for Standard of Care treatment i.e. Radiation, Chemotherapy
• Ensure that Clinical are sent to our Utilization Review Department (STAT) and help navigate so that there are no delays in the process
• Works with Stop Loss and RPB Vendors, ensuring that all information required by Stop Loss has been furnished by the RPB vendor
• Download/run precert report daily every 3rd week
• Email report to designated team
• Review diagnosis codes to confirm those with qualifying diagnosis to add to the PA spreadsheet

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions
• Paid Time Off
• Mental health support
• Retirement planning
• Financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed