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Member Services Representative

Company: Community Behavioral Health
Location: Philadelphia
Posted on: June 6, 2024

Job Description:

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.

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.
  • Meet with members and their care givers on-site and in the community who may have mental health and drug and alcohol 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, interpretation, aftercare appointments, complaints, grievances, appointment reminders and other member requests.
  • Attend 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 during the weekend as needed.
  • Represent DBH/IDS/CBH professionally at all times. Position Requirements:
    • Education: Bachelor's Degree in a related field or a high school diploma with 2 years of experience in the field.
    • 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 proficiency in Microsoft Word and Excel; ability to input data at a minimum of 20 WPM.
    • Excellent telephone communication and customer service skills.
    • Ability to learn quickly.
    • Adaptability, availability to work weekend or essential staff shifts if needed.
    • Ability to speak a second language preferred.
    • Able to effectively solve problems with limited consultation with a supervisor.
    • Good listening skills.
    • Ability to demonstrate leadership and serve as a role model.
    • Ability to work as part of a team; build relationships internally and externally.
    • Self evaluate and accept feedback.
    • Ability to navigate crisis situations.
    • Forward thinking.
    • Ability to understand how Member Services fits into DBH/IDS. Work Conditions (including travel, overtime required, physical requirements and occupational exposure):
      • Requires ability to travel, including out-of-state and overnight, as needed.
      • Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, 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

Keywords: Community Behavioral Health, Philadelphia , Member Services Representative, Sales , Philadelphia, Pennsylvania

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