INTEGRA MLTC, INC.

Member Services Representative

General Information
Location  1981 MARCUS AVE SUITE 100
Lake Success, NY 11042
United States
Employee Type  Full-Time
Job Category  Care Coordination
Description

General Purpose/Scope:

The Member Care Representative works in conjunction with the Care Management Team to ensure the timely implementation of quality services to Integra’s members.

 

Responsibilities Include:

  • Coordinates with members, vendors and providers to ensure timely delivery of quality in-home services that are aligned with members’ service plans.
  • Ensures services are in place for all newly enrolled members and that services are ended timely & appropriately for dis-enrolling members.
  • Confirms all documentation is complete, authorizations are received by vendor/provider, and member’s services/supplies are in place.
  • Responsible for the initiation, suspension, adjustment, or resumption of all services/supplies including DME, DMS, PCA, CDPAP, ADHC, SDC, Lifeline PERS, Authorization SOS, Skilled Services, etc.
  • Uses appropriate billing codes/modifiers and works with Billing & Provider Relations as needed to ensure accurate billing for services.
  • Develops and maintains effective working relationships with members, families, advocates, service providers, and all members of the care management team.
  • On an ongoing basis, monitors and ensures the timely execution and delivery of services to members, ensuring there are no lapses in service.
  • Maintains and updates member records with pertinent information as necessary.
  • Handles member, vendor, and provider requests for information and member materials
  • Obtains MD Orders, prescriptions, forms and all other documentation necessary from members and providers to ensure good quality service
  • Procures missing documentation as needed and ensures that all required documentation is present, complete, and accurate in Care Compass.
  • Mails/Faxes documentation to members and vendors as needed (Care Plan, NOAs, CDPAP forms).
  • Completes Member Engagement Questionnaire for new enrollees.
  • Daily Care Management communication & follow-up.
  • Fields member and provider telephone calls, responding to inquiries and resolving information requests.
  • General office duties such as sorting mail, faxing, scanning, filing, updating and printing documents
  • All other duties and responsibilities as assigned

 

Qualifications:

  • Minimum High School Diploma, Bachelor’s Degree preferred.
  • Minimum of two years of administrative experience
  • Previous experience working with Health Care Insurances
  • Knowledge of Health Care Organizations, Home Care and/or Long term Home Care Agencies.
  • Knowledge of Medicaid eligibility requirements and MLTC processes and regulatory requirements
  • Professional demeanor

 

Skills/Abilities:

  • Demonstrated ability to organize, problem solve and complete tasks within designated time frames
  • Self-starter with high level of accountability and responsibility
  • Excellent written, verbal, and interpersonal communication skills
  • Exemplary customer service skills
  • Highly organized and able to effectively manage multiple priorities
  • Bilingual ability an asset
  • Proficient in Microsoft Word & Excel a plus

 

Licenses/Certifications:

  • Customer Service Certification a plus

 

Integra is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind.  Integra is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Integra are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, sex, sexual orientation, gender identity, national origin, veteran or disability status, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. Integra will not tolerate discrimination or harassment based on any of these characteristics. Integra encourages applicants of all ages.

 

If this opportunity sounds exciting and challenging to you, please click “Apply” now!

 

Requirements