Member Services Specialist

Intermountain Centers is one of the largest statewide behavioral health and integrated care organizations in Arizona, offering a supportive and inclusive environment for career growth.

About the role

The Member Services Specialist ensures all members and customers have a positive experience by addressing their needs, questions, and concerns. This role also validates payer information prior to and during service provision.

Responsibilities

• Enrollment Support (40% Job Effort)
  • Guide members through the enrollment process.
  • Verify eligibility prior to enrollment, understanding insurance restrictions for each program.
  • Validate insurance eligibility within 24 hours of new member chart setup by Medical Receptionist.
  • Set up initial EHR chart and verify insurance eligibility for new walk-in members.
  • Validate member eligibility and benefit plans weekly for future appointments.
  • Explain coverage details, including co-pays, deductibles, and out-of-pocket maximums.
  • Complete thorough verification of benefits (benefit plan, co-pays/HSA/HRA, co-insurance, prior authorization requirements).
  • Initiate requests for initial prior authorization and pass to Quality Management for maintenance.
• Claims Processing Assistance (30% Job Effort)
  • Reconcile member roster with health plan/AHCCCS/Medicare/etc. (Primary Coverage) twice per week.
  • Verify member eligibility throughout service provision.
  • Update member records as needed.
  • Coordinate with the claims/billing department to ensure accurate processing of claims.
  • Review and correct the unbilled services report twice per week.
  • Correct all claims/billing discrepancies within 3 business days of notification.
  • Ensure all critical elements are end-dated in the EHR and discharge within 24 hours of notification.
  • Report Health Plan and Claim discrepancies to designated department staff, particularly regarding eligibility and payers.
• Referral Management (15% Job Effort)
  • Respond to all referrals and request additional information when needed.
  • Work with all programs to respond timely to referring programs/coordinators and upload required documents.
  • Coordinate scheduling of services with program staff.
• Administrative Support to Medical Receptionist (10% Job Effort)
  • Provide back-up support when Medical Receptionist is on PTO/PSL or in meetings.
  • Schedule appointments and manage calendars for behavioral health providers.
  • Maintain accurate and up-to-date member records in electronic health systems.
  • Handle correspondence, including emails and phone calls, professionally.
• Other (5% Job Effort)
  • Address member concerns, escalating as needed to Subject Matter Expert (S.M.E.).
  • Perform other duties as assigned or necessary.
  • Participate in monthly supervision with State Member Services Manager.
  • Participate in Member Services training as directed.
  • Integrate with Program Staff, attend Program Team meetings and events, and comply with office and attendance policies.
  • Answer multiline phone system.
  • Maintain an approved schedule and acceptable level of attendance.

Requirements

• High school diploma or GED.
• Two years of customer service experience in the healthcare industry (medical or behavioral health).
• Experience with Electronic Health Records preferred.
• Extensive knowledge of eligibility and referral processes.
• Minimum 21 years of age.
• Valid AZ DPS Level I fingerprint clearance card (must maintain throughout employment).
• CPR, First Aid, AED certification, if required (must possess upon hire and maintain).
• Initial current negative TB test result, if required (provided by employer).

Benefits

• Top-level compensation packages.
• Exceptional health, dental, and disability benefits.
• Career and compensation advancement programs.
• Student loan forgiveness programs.
• 401k company match.
• Bilingual pay differential.
• Holiday, PTO, and employer-paid life insurance.
• Clinical licensure supervision and reimbursement.
• Evidence-based treatment approaches, training, and supervision.