The Membership Specialist performs all aspects of Membership, which includes front and back office operations, screening and applying members for benefits, general scheduling, enrollment and registration, maintenance of member data in the electronic health record, and maintaining the general state of, and member flow through, the front lobby and immediate property.
Essential Duties and Responsibilities
- Performs several front and back office functions that are related to appointments, insurance verifications, collection of fees, and providing member training on use of Kiosks.
- Performs several customer service functions related to maintaining the lobby and front office areas and ensuring members receive a positive customer service experience while waiting.
- Performs several medical records functions related to the maintenance of member’s records and processing of requests for records.
- Performs several functions related to member benefits that ensure that members’ insurance information is current, they are eligible for the requested service, and assisting with the screening or application of state funded benefits.
- Performs several registration functions that ensure a member’s record is opened and ready for clinical services to begin and gathering pertinent information, releases, and identifications.
- Performs several telephonic, scheduling, and resource functions that ensure callers are routed to the appropriate contacts, messages are documented according to protocol, or providing general information regarding available resources within the community.
- Assisting in the quality management process by facilitating the dissemination of information aimed at collecting satisfaction data or issue resolution.
- Works collaboratively with all levels of staff to ensure effective Membership operations.
- Performs other duties as assigned in keeping with the growth and general responsibilities of the position.
- Demonstrates a professional appearance, demeanor, and interaction with staff, members, and visitors.
- Demonstrates ability to plan and prioritize work; anticipate workflow; work with frequent interruptions.
- Demonstrates the ability to multitask in a fast-paced environment.
- Demonstrates understanding of AHCCCS, eligibility and services, and the application process for publicly funded benefits.
- Demonstrates ability to maintain accurate medical records systems.
- Demonstrates the ability to perform accurate and timely data entry into the appropriate systems.
- Demonstrates the ability to communicate effectively orally and in writing.
- Demonstrates the ability to coordinate and collaborate effectively in a team setting.
- Demonstrates the consistent ability to relay accurate information to members, staff, and outside agencies.
- Demonstrates knowledge of HIPAA and other privacy regulations.
- Demonstrates initiative and self-management in performing follow-through on tasks, duties, and assignments.
- Demonstrates ability to gather information from multiple electronic systems.
- Applies appropriate office procedures.
- Demonstrates ability to work effectively with staff and the public.
- Demonstrates professional telephone etiquette and ability to handle high volume of calls.
- Demonstrates ability to work independently and to coordinate and make decisions involving all aspects of Membership operations.
The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Skills / Requirements
- High school diploma or equivalent, AND combination of training and experience equivalent to 1 year of work history that demonstrate progressively increased responsibility, AND combination of training and experience equivalent to 1 year using electronic data systems OR
- Completion of related Certification or Associate's degree may substitute for the required experience.
- Bilingual skills a plus.
- Use of Microsoft Office programs Word, Excel, and Outlook.
- CPR and First Aid obtained no later than the first 60 days from hire.
- Fingerprint Clearance obtained no later than the first 90 days from hire.
- Familiarity with a variety of computer software used for researching, tracking, data entry/processing, and reporting information, i.e. AHCCCS Online, Excel, Word, and various statistical or graphics programs.
- Knowledge of administrative procedures, office equipment, and principals for providing excellent customer service.
- Knowledge of electronic health systems, records standards, and current statutes pertaining to protected health information while maintaining confidentiality and compliance with HIPAA and other privacy regulations.
- Knowledge of AHCCCS, insurance benefits, and determination of eligibility and/or enrollment.
- Ability to maintain professional appearance, demeanor, and working relationships with staff, members, visitors, and the community at large.
- Ability to apply tactful, adaptable, and professional communication skills with a variety of personalities, cultures, and linguistically diverse backgrounds.
- Ability to evaluate facts or situations to determine appropriate actions and resolve complex aspects of Membership operations.
- Ability multi-task, anticipate workflow, plan and prioritize while working with frequent interruptions in a fast-paced environment.
- Ability to work independently and as a team to coordinate and make decisions, follow-through with all tasks, and escalate crisis situations to the appropriate staff.