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Member Services Specialist I
9994 South Harrison Road Tucson, AZ 85748 US
Staff Matters, LLC a subsidiary of NSC Technologies has an immediate opening for Member Services Specialist I.
Job Title: Member Services Specialist 1
Pay rate: $17 per hour
Hours: M-F – 8-5 p.m.
• Verify Eligibility prior to enrollment with an understanding and knowledge of acceptable and/or restrictions with insurance to each program.
• Monitors and maintain Residential Direct Enrollments within the Electronic Health Records (EHR) within 24 hours of notification.
• Enters Rapid Responses within two hours of notification.
• Enters new client data into EHR system for initial setup and updates information as needed in system to ensure information is current.
• Responds to all referrals; requests additional information when needed.
• Works with all programs to respond timely to referring programs/coordinators; uploads required documents as directed.
• Ensure Members have Discharge summaries, have supervisor approval and DC Reason is clear and appropriate.
• Ensure all critical elements are end dated in the EHR, discharge within 24 hours of notification.
• Ensures all members are reassigned/discharged and/or meet the criteria to be transferred to another program.
• Ensures and verifies member eligibility throughout service provision.
• Monitors EHR(s) for Health Plan changes, updates Payers, notifies claims and assigned clinical team.
• Reports and works with appropriate Health Plans with Insurance discrepancies.
• Manages Claim discrepancies pertaining to eligibility and payers. Reviews, researches, notifies Member Services regarding loss of eligibility.
• Verify Commercial insurance, through a portal or via telephone.
• Complete a thorough verification of benefits (includes co-pays/HSA/HRA, co-
• insurance, prior authorization requirements).
• Verify Medicare benefits.
• Enters, uploads, monitors and maintains prior authorizations for Residential and Foster Care Programs. In the EHRs and Health Plan portals.
• Conduct weekly audits and follow up with appropriate departments.
• Uploads, manages and maintains the demographic files for all agencies.
• Troubleshoots and works with programmers to resolve file issues or to ensure successful integration of specification updates from AHCCCS.
Education - High School Diploma or GED required.
• Experience – Two (2) years of customer service experience working in the healthcare industry (medical or behavioral health). Experience with Electronic Health Records required.
o Minimum 21 years of age.
o Arizona Driver’s License, 39-month Motor Vehicle Report and proof of vehicle registration and liability insurance that meets insurance requirements.
o Must possess Level 1 fingerprint clearance.
o CPR and First Aid certification (Employer provides).
FOR IMMEDIATE CONSIDERATION CONTACT, Darrell Griffiths, Recruiter
At STAFFMATTERS our company culture is strong! You work hard for us and in return we want to provide you with as many benefits and resources as we can:
- Medical Coverage
- Short- and long-term disability coverage
- Identity Theft Protection
- Legal Assistance
- Long Term Opportunities
- Training and Career Growth Opportunities
- The chance to be a part of an amazing team
STAFFMATTERS is committed to connecting good people with good jobs!
STAFFMATTERS is an innovative staffing firm that specializes in placing qualified administrative, light industrial, skilled, technical and professional talent in virtually any market. Our meticulous dedication to Quality and Safety is a testament to our success. We are The Staffing Experts!
STAFFMATTERS is a drug free company. STAFFMATTERS is an EOE AA/M/F/VHo/D.