Member Services Specialist

Community Partnership of Southern Arizona Tucson, AZ
COMMUNITY PARTNERS

JOB DESCRIPTION

JOB TITLE: Member Services Specialist

GENERAL DESCRIPTION OF RESPONSIBILITIES:

Under direct supervision, is responsible for the administrative day to day support of clinical staff and members (patients).

MINIMUM QUALIFICATIONS

High school diploma or GED plus two years’ experience in a primary care or behavioral health office setting

Bilingual preferred

Knowledge of Internet software, word processing, ability to type 45 words per minute accurately

Ability to navigate Windows environment

Extensive knowledge of eligibility and referral processes

Knowledge of electronic health records systems (NextGen preferred)

Excellent organizational skills

Knowledge of health care field and medical office protocols/procedures

Must be able to work in a diverse, multi-cultural environment and be sensitive to the service population’s cultural and socioeconomic characteristics

The ability to interact effectively with other team members in a team based approach to care management

PHYSICAL/COGNITIVE ABILITIES

Ability to operate a personal computer and telephonic communications equipment

Ability to read the screen of a personal computer monitor

Ability to read handwritten and printed documents and records

Ability to perform analysis of information

Ability to move around an office environment

Ability to communicate business matters verbally and in writing

Ability to sit for long periods of time.

DUTIES AND RESPONSIBILITIES

Providing quality customer service to members.

Receives and screens incoming telephones calls. Answers questions and provides information regarding CPIH services.

Direct new and existing members to services.

Receiving or making referrals for the member.

Verifying patient insurance eligibility.

Facilitates enrollment of potential members into the behavioral health system.

Scheduling and coordinating appointments for members, this includes urgent/crisis enrollments.

Follow up with members regarding missed appointments.

Returning messages within 24 hours (same day preferred).

Convert Claimtrak data into NextGen (charts, insurances, PCPs, demographics, etc).

RBHA Demographic files: submit type 1, 2, 4 and 834’s

Process RBHA and Inter-RBHA transfers.

Cenpatico/MMIC Deliverables.

Process SMI determination packets.

Roster Reconciliation; 834 demographics.

Work all reports that come from Data Team – (wrong insurances, expired members, open programs, problems with data)

Process all medical records request. (QOC’s, Social Security etc.)

May perform data entry into computer database systems or spreadsheet documents as directed.

Responsible for following any policies, procedures, and controls established by the organization, the HIPAA Privacy Officer, and/or the HIPAA Security Officer regarding access to, protection of, and the use of the PHI.

Performs other duties as assigned.

REQUIRED COMPETENCIES

Business Ethics: Demonstrates principled performance and sound business ethics, showing consistency among principles, values and behaviors to build trust and credibility.

Customer Service: Focuses one’s efforts on discovering and meeting internal and external customers’ needs in a manner that provides satisfaction for the customer within the resources that can be made available.

Initiative: Evaluates, selects and acts on various methods and strategies for solving problems and meeting objectives before being asked or required to do so; self-directed rather than passively complying with instructions or assignments.

Innovation: Generates novel and valuable ideas and uses these ideas to develop new or improved processes, methods, systems, products or services.

Job Knowledge: Demonstration of technical, administrative, managerial, supervisory, or other specialized knowledge required to perform the job.

Oral Communications: Effectively transfers thoughts and expresses ideas verbally in individual or group situations.

Planning & Organization: Establishes a systematic course of action for self or others to assure accomplishment of a specific objective.

Teamwork: Willingly cooperates and works collaboratively toward solutions which generally benefit all involved parties; works cooperatively with others to accomplish organization objectives.

Written Communications: Expresses ideas, thoughts and concepts clearly in writing, using correct and appropriate grammar, organization, and structure.

Work Quality: Reports to work as scheduled, is punctual to work and meetings, takes responsibility for own work and actions, and keeps commitments.

Cultural Competency: Displays cultural sensitivity and demonstrates the ability to form constructive and collaborative working relationships with others from diverse cultural backgrounds.

Professional Development Competency: Displays awareness of special skills and knowledge required for position. Seeks to develop professionally, completing required trainings within established timelines.

CPI is an equal opportunity employer. CPI does not discriminate based on age, ethnicity, race, sex, gender, religion, national origin, creed, tribal affiliation, ancestry, gender identity, sexual orientation, marital status, genetic information, veteran status, socio-economic status, claims experience, medical history, physical or intellectual disability, ability to pay, source of payment, mental illness, and/or cultural and linguistic needs, as well as any other class protected by law.