Member Services Specialist

Intermountain Centers•Tucson, AZ

About The Position

The Member Services Specialist helps ensure members and customers have a positive experience by addressing their needs, questions, and concerns. The role also validates payer information before and during service provision. Responsibilities include guiding members through enrollment, verifying insurance eligibility and benefits, explaining coverage, initiating prior authorization requests, supporting claims processing, reconciling member rosters, and resolving eligibility or billing discrepancies. The specialist also manages referrals and coordinates service scheduling with program staff. The position provides administrative backup to the Medical Receptionist, including scheduling appointments, maintaining electronic health records, managing calendars, and handling correspondence. The specialist responds to member concerns, participates in supervision, training, and program meetings, follows office and attendance policies, and performs other related duties as assigned.

Requirements

High school diploma or GED.
Two years of customer service experience in the healthcare industry, including medical or behavioral health.
Minimum age of 21.
Valid Arizona DPS Level I fingerprint clearance card, maintained throughout employment.
CPR, First Aid, and AED certification if required; must be held upon hire and maintained throughout employment.
Initial current negative TB test result if required; employer provides the test.

Nice To Haves

Experience with Electronic Health Records.
Extensive knowledge of eligibility and referral processes.

Responsibilities

Guide members through enrollment and verify eligibility before enrollment, including understanding insurance restrictions and program requirements.
Validate insurance eligibility for new member charts within 24 hours of setup and establish initial EHR charts and verify eligibility for new walk-in members.
Validate eligibility and benefit plans weekly for members with future appointments.
Explain coverage details, including co-pays, deductibles, and out-of-pocket maximums.
Verify benefit plans, co-pays, HSA/HRA, co-insurance, and prior authorization requirements.
Initiate requests for initial prior authorization and pass them to Quality Management for maintenance.
Reconcile member rosters with health plans, AHCCCS, Medicare, and other primary coverage sources twice per week.
Verify member eligibility throughout service provision and update member records as needed.
Coordinate with the claims and billing department to support accurate claims processing.
Review and correct the unbilled services report twice per week.
Correct claims and billing discrepancies within three business days of notification.
Ensure critical elements are end-dated in the EHR and complete discharge within 24 hours of notification.
Report health plan and claim discrepancies, including eligibility and payer issues related to loss of eligibility, to designated department staff.
Respond to referrals, request additional information when needed, upload required documents as directed, and coordinate service scheduling with program staff.
Provide backup support to the Medical Receptionist during PTO/PSL or supervisor meetings.
Schedule appointments and manage calendars for behavioral health providers.
Maintain accurate and up-to-date member records in electronic health systems.
Handle email and phone correspondence professionally and answer a multiline phone system.
Address member concerns and escalate them to a Subject Matter Expert as needed.
Participate in monthly supervision with the State Member Services Manager and attend training as directed.
Integrate with program staff by participating in program team meetings and events, and comply with office and attendance policies.
Maintain an approved schedule and acceptable attendance.
Perform other duties as assigned or as necessary in the general nature of the position.