AFMC Member Service Rep II (English or Bilingual)
Looking to work for Arkansas Foundation for Medical Care as a Medicaid Member Service Representative II? Please go to the website listed below to find out more about the position or to apply online. Go to afmc.org to learn more or apply online.
Equal Opportunity Employer / Veterans / Disabled AFMC, Inc. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability or any other status protected by federal, state and/or local law.
Official Schedule (after training) 9:00 a.m. – 5:30 p.m.
Scope of Position Maintain knowledge of the Arkansas Medicaid program and provide effective and efficient customer service to Medicaid Members for Arkansas Medicaid Program or Premium assistance programs. Respond to and resolve grievances and complaints; provide accurate and up‑to‑date information and assist in resolving issues or concerns about healthcare coverage. Familiarize Members with enrollment in a qualified health plan using the ACCESS Arkansas portal; assign or change PCPs at request of Members; assist Members who seek dental care coordination services by providing dental benefit information, finding a dentist or dental specialist, scheduling dental appointments, and arranging transportation. Assist eligible Medicaid Members in changing their assignment in managed care dental plans. Serve as subject‑matter expert on assigned contract deliverables. Document services rendered in the appropriate format and system as designated by AFMC and provide reporting as required. Support the organization’s mission, vision, and values by exhibiting honesty, excellence, accountability, respect, and teamwork.
Essential Job Functions
Coordinate communication between various components of the AR Medicaid program.
Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment, including contract deliverables, policies and procedures, resources, current research, reports, and trends.
Resolve customer/client requests, including research, referral, policy review, revision, development, documentation and follow‑up in accordance with established policy/procedures.
Communicate effectively with customers and/or recipients and develop and maintain working relationships as necessary to meet contract deliverables.
Act as a resource to internal and external customers for information pertaining to specialty area focus.
Work with Information Services to coordinate system developments and customizations.
Assist in the creation and maintenance of necessary reports/documents to track and report project information. Prepare ad‑hoc reports and/or statistics as directed.
Monitor specific items within the area of focus, provide recommendations/feedback to external customers for quality improvement, and follow through for compliance of recommendations for improvement.
Acquire training and knowledge in all other areas of Member Services to assist as needed with the overall operation of the Member Services department.
Assist PASSE Members in changing their initial auto‑assignment to a PASSE entity, complete the change in the MMIS system and document all PASSE correspondence using the JIRA ticketing system.
Maintain knowledge to efficiently function using Contractors software: MMIS, CURAM, JIRA ticket system, and ANSWER.
Adhere to daily quotas to meet contract deliverables as needed.
Adhere to format, content and style guidelines, ensuring usability, accuracy, consistency, and quality.
Communicate needs and requests to other team members as appropriate.
Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
Adhere to AFMC Quality Standards of Excellence.
Perform additional duties as assigned.
Knowledge, Skills and Abilities
Intermediate level computer skills (Excel, Word, PowerPoint, Outlook)
Type 25 wpm
Excellent business English and spelling
Ability to maintain confidentiality
Strong oral and written communication skills
Creativity, customer service orientation, attention to detail
Ability to meet deadlines, multitask, prioritize, and work collaboratively or independently
Initiative and professionalism
Strong organizational and problem‑solving skills
Project management skills
Ability to read, interpret and apply laws, rules and regulations
Knowledge of quality improvement processes and techniques
Time management skills
Job Requirements Physical and sensory requirements (with or without the aid of mechanical devices): mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress, and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions with or without reasonable accommodations.
Education High school diploma (required).
Experience Required: Two (2) years experience within the healthcare arena, understand Medicaid guidelines, customer relations, and call‑center experience. Desirable: Experience within the healthcare arena and understanding of Medicaid guidelines.
Bilingual Experience Required: Bilingual English/Spanish with two (2) years experience within the healthcare arena and understanding of Medicaid guidelines. Desirable: Experience within the healthcare arena and understanding of Medicaid guidelines.
Internet Requirements Reliable, high‑speed wireless internet service (Wi‑Fi). An upload speed of at least 5 Mbps is required to support softphone functionality.
Equal Opportunity Employer / Veterans / Disabled Equal Opportunity Employer / Veterans / Disabled. EEO is the law. AFMC invites any employee and/or applicant to review the Company’s affirmative action plan. This plan is available for inspection upon request by phone (501) 212‑8796, fax (501) 212‑8797, or U.S. mail: Attn: Human Resources, 1020 West 4th Street, Suite 400, Little Rock, AR 72201.
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Equal Opportunity Employer / Veterans / Disabled AFMC, Inc. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability or any other status protected by federal, state and/or local law.
Official Schedule (after training) 9:00 a.m. – 5:30 p.m.
Scope of Position Maintain knowledge of the Arkansas Medicaid program and provide effective and efficient customer service to Medicaid Members for Arkansas Medicaid Program or Premium assistance programs. Respond to and resolve grievances and complaints; provide accurate and up‑to‑date information and assist in resolving issues or concerns about healthcare coverage. Familiarize Members with enrollment in a qualified health plan using the ACCESS Arkansas portal; assign or change PCPs at request of Members; assist Members who seek dental care coordination services by providing dental benefit information, finding a dentist or dental specialist, scheduling dental appointments, and arranging transportation. Assist eligible Medicaid Members in changing their assignment in managed care dental plans. Serve as subject‑matter expert on assigned contract deliverables. Document services rendered in the appropriate format and system as designated by AFMC and provide reporting as required. Support the organization’s mission, vision, and values by exhibiting honesty, excellence, accountability, respect, and teamwork.
Essential Job Functions
Coordinate communication between various components of the AR Medicaid program.
Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment, including contract deliverables, policies and procedures, resources, current research, reports, and trends.
Resolve customer/client requests, including research, referral, policy review, revision, development, documentation and follow‑up in accordance with established policy/procedures.
Communicate effectively with customers and/or recipients and develop and maintain working relationships as necessary to meet contract deliverables.
Act as a resource to internal and external customers for information pertaining to specialty area focus.
Work with Information Services to coordinate system developments and customizations.
Assist in the creation and maintenance of necessary reports/documents to track and report project information. Prepare ad‑hoc reports and/or statistics as directed.
Monitor specific items within the area of focus, provide recommendations/feedback to external customers for quality improvement, and follow through for compliance of recommendations for improvement.
Acquire training and knowledge in all other areas of Member Services to assist as needed with the overall operation of the Member Services department.
Assist PASSE Members in changing their initial auto‑assignment to a PASSE entity, complete the change in the MMIS system and document all PASSE correspondence using the JIRA ticketing system.
Maintain knowledge to efficiently function using Contractors software: MMIS, CURAM, JIRA ticket system, and ANSWER.
Adhere to daily quotas to meet contract deliverables as needed.
Adhere to format, content and style guidelines, ensuring usability, accuracy, consistency, and quality.
Communicate needs and requests to other team members as appropriate.
Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
Adhere to AFMC Quality Standards of Excellence.
Perform additional duties as assigned.
Knowledge, Skills and Abilities
Intermediate level computer skills (Excel, Word, PowerPoint, Outlook)
Type 25 wpm
Excellent business English and spelling
Ability to maintain confidentiality
Strong oral and written communication skills
Creativity, customer service orientation, attention to detail
Ability to meet deadlines, multitask, prioritize, and work collaboratively or independently
Initiative and professionalism
Strong organizational and problem‑solving skills
Project management skills
Ability to read, interpret and apply laws, rules and regulations
Knowledge of quality improvement processes and techniques
Time management skills
Job Requirements Physical and sensory requirements (with or without the aid of mechanical devices): mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress, and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions with or without reasonable accommodations.
Education High school diploma (required).
Experience Required: Two (2) years experience within the healthcare arena, understand Medicaid guidelines, customer relations, and call‑center experience. Desirable: Experience within the healthcare arena and understanding of Medicaid guidelines.
Bilingual Experience Required: Bilingual English/Spanish with two (2) years experience within the healthcare arena and understanding of Medicaid guidelines. Desirable: Experience within the healthcare arena and understanding of Medicaid guidelines.
Internet Requirements Reliable, high‑speed wireless internet service (Wi‑Fi). An upload speed of at least 5 Mbps is required to support softphone functionality.
Equal Opportunity Employer / Veterans / Disabled Equal Opportunity Employer / Veterans / Disabled. EEO is the law. AFMC invites any employee and/or applicant to review the Company’s affirmative action plan. This plan is available for inspection upon request by phone (501) 212‑8796, fax (501) 212‑8797, or U.S. mail: Attn: Human Resources, 1020 West 4th Street, Suite 400, Little Rock, AR 72201.
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