Member Services Representative at Asian Health Services – Oakland, California

Member Services Representative

Asian Health Services, founded in 1974, provides medical, dental, and behavioral health services to more than 50,000 patients. Our approach to well-being focuses on whole patient health for all. We go beyond our clinic walls and invest in our communitys overall health. We know that income, housing, and environmental struggles lie at the heart of poor health. Thats why we also address food insecurity, youth leadership, and culturally competent care while working towards supporting safer streets and vibrant communities.
LOCATION: HMC
JOB SUMMARY:With supervision from the Senior Member Services Manager, learns to determines initial and continuing eligibility for health and social services by screening and interview patients to assess financial payer sources and status.
Note: This role is grant funded through December 2026. Essential Job Function - Patient Eligibility

• Conducts patient financial screening to determine eligibility for County Medical Services Program (CMSP), Medicare, Medi-Cal, Healthy Families, and other payment sources.
• Assists patients in completing forms and applications for payment programs. Follows up on patients pending status for payment programs.
• Assists patients in selecting a primary care provider and a health insurance plan, including PPO and HMO.
• Contacts health plan and insurance company to verify patients insurance coverage and referral requirement; may assist in completing Medi-Cal applications and perform status follow-up with the countys Medi-cal worker.
• Answers inquiries and provides counseling regarding Medi-Cal and Medicare and their managed care systems, and other social service needs.
• Update patient financial information in the computer system and follow up on patients pending status for a payment program,
• Answer incoming phone calls that are directed to the Member Services Department and make appointments for members.
• Assists the Member Services Manager in conducting member exit interviews and in processing monthly member rosters for all AHS contracted managed care plans.
• Provide input to Member Services Manager in developing and maintaining eligibility criteria and procedures consistent with AHS goals and objectives.
• Provides advocacy for AHS patients/members due to government welfare reform and immigration policies.
• Conduct medical history intake interviews for all patients including new patients, newborn infants, and perinatal patients.

Other Duties

• Meets regularly with Member Services Manager to discuss patient eligibility problems and/or other issues affecting the department.
• May provide back up for the front desk patient services representative, interpreting services, and Saturday clinic as requested.
• May provide back up for Member Services Manager (Level II only), solving complex problems as necessary.
• Assists the Billing department regarding billing problems as requested.
• May attend staff and department meetings, as well as special training sessions related to new eligibility criteria for payor programs.
• May participate in special AHS internal committees and task forces, as appropriate.
• [For Intermediate Level] May act as lead and troubleshoot on issues for Billing department staff, Patient Services Representatives, Providers, and Medical Interpreters.
• Perform other duties as required.

Minimum Qualifications

• Ability to speak English and Cantonese and/or Mandarin.
• [Entry Level] High school diploma or GED with two years related work experience in a community health setting; or equivalent combination of education and experience
• [Intermediate Level] High school diploma or GED with two years of college course work in a related field and two years related work experience in a community health setting; or equivalent combination of education and experience

Preferred Qualifications

• Commitment to working in the Asian community, to community health care with familiarity with community health clinics preferred.
• Health Families certification preferred

Certifications, Licenses, Registrations

• HIPPA Training Certificate

On-call employees does not qualify for company benefits.
$31.15 - $34.33 an hour