Member Services Specialist
CurrentAnswer incoming phone calls from consumers inquiring about behavioral health services, integrated care services and primary care services. Responsible for coordinating intakes, verifying consumer eligibility prior to enrollment, maintaining monthly reports ensuring all consumers enrolled in the agency have active insurance coverage. Assist consumers in reapplying for and renewing either AHCCCS or marketplace.gov coverage. Specializing in all areas of RBHA demographic submissions and reconciliations. This necessitates working with tight deadlines on a daily basis to meet the minimum performance standard for demographic submission and compliance. Develop and maintain strong and collaborative working relationships with the RBHA, other ICCAs and specialty providers to address technical and systems issues. Collaborate extensively with the RBHA to coordinate transfers for consumers that have moved out of the Tucson area and providing detailed information to the RBHA on specific issues preventing an Episode of Care from being accepted. Working directly with consumers on a daily basis in person and telephonically is supported by extensive customer service skill set and experience in de-escalation techniques. Working closely with consumers expressing concerns regarding quality and availability of care to get to the root of their issues and connect them to the proper agency, RBHA or community resources to address their concerns. Coordinate with other agencies to transfer consumers to and from Assurance Health and Wellness. Partnered with Quality Manager completing monthly chart audits. Worked under Billing Specialist on a monthly basis to assist with claim rejections. Work closely with team to develop work flows as well as various procedures and training materials. Ability to quickly develop and maintain proficiency with multiple electronic health records at one time.