Member Services Representative

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Position Overview:

The Member Services Representative is responsible for responding to incoming calls from CBH members, their families, in and out of network providers and other outside sources regarding behavioral health services. The Member Services Representative conducts face to face interviews with members, checks insurance eligibility, makes referrals for outpatient appointments, assists in grievances and complaints process, participates in community relations events, attends ongoing trainings, and actively participates in ongoing meetings and projects involving DBH/CBH initiatives. Member Services Representatives are advocates for CBH members and assist them in negotiating the behavioral health and drug and alcohol systems.

Core Expectations:

CBH will hold each employee accountable to the following expectations which align with our mission, vision, and corporate code of conduct.

• Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner working within the rules, regulations, and guidelines of the company. Become knowledgeable and experienced in the fundamental functions of a Member Services Representative.
• Serve as a role model by exemplifying professional behavior, language, skills, and attire in order to promptly and accurately service the needs of members and their families
• Sets the Standard for Trust, Integrity, Transparency by adhering to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner
• Promotes and Cultivates Intellectual and Cultural Diversity and acceptance within CBH and with all members by honoring and respecting their individuality, dignity and rights
• Be able to offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs, exercising judgment and personal responsibility to protect privacy of others. Actively participate in required department meetings and complete mandatory trainings.
• Maintain high levels of advocacy and confidentiality to ensure the success of CBH and our mission.

Essential Functions:

With supervision a Member Services Representative will perform the following functions:

• Guide telephone callers in navigating through behavioral health and drug and alcohol systems of DBH, IDS and CBH.
• During Community events, may meet with members and their caregivers in the community who may have mental health and substance use diagnoses.
• Refer members to appropriate levels of care and act as a liaison between members and providers.
• Directing members in obtaining health insurance and guiding members through conflicts with behavioral health Medicaid insurance.
• Research network opportunities and out of network resources for members as needed.
• Advocate for members when needed; be the member "voice".
• Maintain detailed documentation of all interactions with members.
• Adhere to client confidentiality in accordance with HIPPA guidelines.
• Schedule assessments, evaluations, complaints, grievances, appointment reminders and other member requests as deemed appropriate.
• May assist grievances and complaint hearings as an advocate for our members.
• Cross collaboration with other DBH, IDS and CBH departments.
• Address members with serious mental health or suicidal situations if needed.
• Availability to work a minimum of one weekend per month.
• Represent DBH/IDS/CBH professionally at all times.

Position Requirements:

• Education: Bachelor’s Degree in the Behavioral Health or related field preferred, or a high school diploma with 2 years of experience in the Behavioral Health field.
• Ability to speak a second language preferred to better support diverse patient populations and reduce communication barriers in care delivery.
• License/Certification: Certifications in Crisis Intervention, Autism, MAT and Customer Service are a plus.
• Relevant Work Experience: a minimum of 2 years of mental health and/or substance abuse experience.

Skills:

• Basic knowledge of Microsoft Word, Excel, and other core technological programs.
• Ability to input data accurately at a minimum rate of 40 words per minute (WPM).
• Excellent customer service and interpersonal skills, with proven experience of handling member inquiries compassionately and resolving care coordination or access issues effectively.
• Strong telephone communication skills, including an approachable demeanor and active listening.
• Ability to learn quickly.
• Adaptability, availability to work weekend or essential staff shifts.
• Ability to effectively solve problems with limited consultation with a supervisor; demonstrates strong initiative and independent judgment.
• Ability to demonstrate leadership and serve as a role model.
• Ability to work as part of a team; build relationships internally and externally.
• Ability to self-evaluate performance, accept and implement feedback appropriately, and self-regulate emotions and reactions in challenging or fast-paced situations.
• Ability to navigate crisis situations.
• Forward thinking.
• Ability to understand how Member Services fits into DBH/IDS.

Core Competencies:

• Teamwork and Collaboration: Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.
• Respect: Treat each other and our members with mutual respect and sensitivity, recognizing the importance of diversity and HIPPA guidelines.
• Member Centric: Focus on the needs of our members by providing valuable aspirate services, promoting relationships by going beyond basic expectations to achieve the best possible outcomes.
• Honesty and Integrity: Be open and honest in all we do. Maintain the highest level of integrity at all times.
• Commitment to Service Excellence: Challenge ourselves to be forward-thinking and committed to providing total member satisfaction, first-in-class service and high quality, innovative programs.
• Compassion and Empathy: Demonstrate appreciation for member’s situation and point of view. Pay attention to emotional cues, listen effectively and show a level of caring about each person’s perspectives and circumstances.
• Initiative / Self-Directed / Problem Solving: Proactively manage time and resources, build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience that all work is done in the most efficient manner while identifying and implementing initiatives without interventions from outside sources.
• Flexibility and Adaptability: Strive to adapt to, accept and embrace change within areas of responsibility
• Communication: Effectively and appropriately share thoughts, ideas and information - both written and oral Respectfully listen to co-workers and members to gain a full understanding of issues/situations

Work Conditions (including travel, overtime required, physical requirements and occupational exposure):

• Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, and pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
• Ability to utilize computers and office equipment to complete daily work responsibilities.
• Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
• Must be able to adapt to continuous changes/demands of the job.

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

Equal Employment Opportunity:

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation: CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.

• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov