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Member Services Representative

Company: Elderwood Health Plan
Location: Tonawanda
Posted on: August 6, 2022

Job Description:

Join Our Team: Are you ready for a rewarding career? Join a company that cares for you, too. Overview:

Immediate opening for a Member Service Associate in Buffalo, NY! LPNs WELCOME TO APPLY!

Elderwood Health Plan is currently seeking a Member Service Associate to join our managed long-term care interdisciplinary (MLTC) team. This is a critical healthcare role as you serve as a main contact for our health plan members, which consists of 100% Medicaid paid services.

In this role, you are responsible for providing customer service and medical office assistance for the non-clinical aspects of our plan members' person-centered plan of care. The person in this role will ideally understand the challenges and needs of the membership, in addition to having experience with using an EMR.

This is a great opportunity for someone who has worked in a primary care physicians office or a large hospital outpatient clinic.

Employee Perks!: 401K Retirement Plan with Company Match, Clean, Neat & Newly Renovated Facility, Close to thruway entrances/exits, Conveniently located on a bus route, Enjoy a fun and diverse work environment, Enjoy being a part of a strong and diverse team, Free On-Site Parking, Generous PTO & holiday package, Life Insurance, Medical, Dental, and Vision insurance, Point-earning employee reward program: redeem for prizes!, Relaxing employee lounge with free iced/hot coffee, Strong leadership, Substantial employee referral program Responsibilities:

Our Member Service Representatives (MSR) are responsible for the non-clinical aspects of an EW Health Plan members' person-centered plan of care and will serve as the primary point of contact for members. An important part of this role is maintaining a high level of professionalism and establishing a rapport with every member

Other tasks include:

Assisting with Member concerns
Handling Member inquiries
Completing necessary authorizations and triaging calls to the necessary team
Interacting/partnering with other departments including claims, intake, enrollment, and provider services to resolve member and provider issues
Assisting the Care Management Team with the following:
discharge preparation
request clinical information
arranging transportation
coordinating medical supply delivery
creation of authorizations within electronic medical record
Participating in special projects as assigned, such as Disease Management, Utilization Management, and Quality Improvement activities
Identifying barriers to member care and elevating awareness of Member or Provider need and collaborating with team to develop solutions
High School Diploma or equivalent; an associate degree preferred
Minimum one (1) year experience within an MLTC or Health Care setting
Minimum of one (1) year experience working with a diverse and medically fragile population
Proficient computer skills, including working knowledge of Microsoft 365 and electronic medical record (EMR)


Customer Service Orientation
Excellent verbal & written communication skills
Managing through systems
Problem solving and analytical thinking
Teamwork & Cooperation

Elderwood expects all current and new employees to be vaccinated against COVID-19. If hired, you will be required to provide proof of vaccination. Employees may request a medical or religious exemption from vaccination.


EOE Statement: WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Keywords: Elderwood Health Plan, Tonawanda , Member Services Representative, Sales , Tonawanda, New York

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