Under the direct supervisor of the Member Services Supervisor, the Member Service Representative will provide support to the Case Management Department. Responsibilities include, but are not limited to the following: data entry of referrals, verification of eligibility, telephone management, faxing, mail handling, filing and chart maintenance. Maintains a high level of customer service to members, other staff at Graybill Medical Group, specialists and all providers. Additional tasks may be assigned to assure expertise in the various support areas. All member services personnel will be cross-trained to assure consistency in service. Compliance with all HIPAA policies as outlined by the HIPAA coordinator. Compliance with all SCMG requirements for handling referrals as outlined in the SCMG manual. Compliance with Policies and Procedures in the Case Management Department.
Ability to answer calls with a clear voice, cheerful/professional attitude, quick turnaround time in responses to the questions, etc. Accurate management of referrals. Ability to greet visitors with a professionally.
Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.

Job Requirements