Membership Specialist
MHC Healthcare - Marana, AZ
posted 17 days ago
About the position
MHC Healthcare is seeking a Membership Specialist to join the utilization and membership team at the MHC Main Health Center, located in the heart of Marana, AZ. The Membership Specialist is responsible for enrollment and eligibility of new patients in need of or interested in behavioral health services. This includes determining eligibility based on income or insurance status, assisting patients with applications for appropriate funding sources, verifying financial or insurance information and completing enrollment and referral entry into the Electronic Medical Record (EMR) and electronic systems of funding sources. The Specialist is also responsible for re-verifying, updating or providing continued patient support after enrollment to ensure financial and insurance information is accurate throughout the enrollment period of the patient. MHC Healthcare is a Federally Qualified Community Health Center (FQHC), with 14 sites in Tucson and Pima County. Our mission is to improve our Community by providing exceptional, whole-person healthcare.
Responsibilities
- Accepts calls from potential BH clients and ensure timely responses.
- Collects information related to patient eligibility, including assessing insurance and Sliding Fee Scale (SFS) eligibility.
- Schedules patients with new intake appointments based on patient eligibility and provider credentialing.
- Updates information in EMR for co-pay amounts, ongoing insurance verification and information regarding eligibility and enrollment collected from patient, insurance or payer sources.
- Regularly reviews and re-verifies insurance, SFS assessments and other financial information to ensure accuracy and certification.
- Notifies clinical staff and support staff when issues arise related to non-payment of charges, or change in eligibility or enrollment.
- Provides assistance and coaching to clinical and support staff to ensure accuracy of billing, payment collections and covered service provision.
- Participates in agency, community and RBHA financial meetings as required requested.
- Observes applicable state and federal laws.
- Assumes responsibility for knowledge of laws and requests clarification, if necessary.
- Maintains general BH and education standards and keeps abreast of BH and State RBHA guidelines by reading and attending in-services and workshops as appropriate and indicated in staff development plan.
- Follows professional and ethical practices when working with clients, client records, families and community personnel.
- Has a thorough knowledge of all MHC policies and procedures.
- Maintains confidentiality of client/family information.
- Uses appropriate incident reporting procedures when documenting unsafe or problematic incidents involving patients, clients and/or staff.
- Completes Incident Report accurately and follows procedures completely.
- Interacts effectively with staff, management, community members and other agency personnel to promote a milieu of trust, productivity and growth.
- Performs appropriate follow through from start to finish with all assigned tasks.
- Maintains professional and technical knowledge by attending educational workshops.
- Maintains a positive attitude towards job responsibilities working collaboratively with all MHC staff members to create a productive, working team.
- Utilizes appropriate channels for reporting/discussing/problems solving or concerns.
- Completes all other tasks as required.
Requirements
- High School Diploma or GED
- Fingerprint Clearance Card through the Arizona Department of Public Safety (or ability to obtain upon hire)
Nice-to-haves
- Financial experience in Behavioral Health (BH) or medical setting preferred.
- Experience with Regional Behavioral Health Authority (RBHA) system and State AHCCCS behavioral health billing preferred.
Benefits
- Medical, Dental, and Vision
- 403(b) with employer contribution
- Short-term disability and other benefits
- Paid time off including 11 holidays plus vacation and sick leave accrual
- Paid bereavement, jury duty, and community service time
- Employee discount for medical services ($500 per year for full-time)
- Education reimbursement ($3,000 per year for full-time)
