Membership Specialist
Alvernon - Tucson, AZ
Full Time
Customer Service


Coordinates and monitors the intake/enrollment process to include front and back office operations, intake/enrollment and financial screenings for individuals with serious mental illnesses, substance abuse problems and general mental health issues.

Essential Duties and Responsibilities

  1. Operates telephone system to answer, screen and forward calls, provides information, schedules appointments, and contacts members to remind them of their scheduled appointments.
  2. Greets visitors, determines nature of business, directs them to appropriate office/person and notifies appropriate person of visitor’s arrival.
  3. Screens clients for eligibility for services to individuals with serious mental illness, substance abuse and general mental health.
  4. Completes a Priority Population Screening tool for all persons requesting services.
  5. Informs clients of financial papers/requirements necessary for the Intake.
  6. Maintains appropriate intake documentation requirements in accordance with agency and funding source requirements.
  7. Interviews clients for potential financial eligibility for multiple counties, State and Federal medical assistance programs to determine residency, household composition, income, assets and medical expenses such as AHCCCS, Food stamps, cash assistance, social security welfare and disability.
  8. Determines client’s behavioral health co-payment/fee responsibilities.
  9. Requests, reviews and verifies personal documents as necessary to apply individual for relevant assistance.
  10. Researches manual files and computer data files to gather or verify data needed for eligibility determinations and/or application processing.
  11. Refers ineligible applicants to other community resources, social service agencies and Medicare supplements
  12. Assures annual financial evaluation update is completed for each client annually.
  13. Pulls medical records for scheduled appointments, and resolves scheduling discrepancies.
  14. Assembles new member files and notifies appropriate staff of record deficiencies.
  15. Processes correspondence to primary care physicians (PCP), other agencies, staff and members, in accordance with policies and procedures related to confidentiality.
  16. Processes subpoenas to assure legality of releases of information and billing for cost in photocopying, etc.
  17. Works directly with members, in coordination with clinical staff, to obtain and process “Release of Information” in accordance with Arizona Revised Statutes and Federal regulations regarding confidentiality.
  18. Verifies hospital admits/discharges daily, transmits/receives relevant records, to ensure continuity of care.
  19. Maintains, inputs, and retrieves data from established database information system.
  20. Returns all inquiry calls within 24 hours excluding weekends and holidays.
  21. Performs other related activities in accordance with agency growth and changes.


  1. High School diploma or equivalent and a combination of training and experience equivalent to three years of related experience with progressively increased responsibility, preferably with automated systems.
  2. Completion of a related Certification, Associate's, or Bachelor's degree may substitute for the required experience.


See Education





Additional Requirements:

  1. Valid Arizona Driver’s license, proof of current insurance and willingness to use personal vehicle.
  2. Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.
  3. 1st Aid, CPR and Fingerprint Clearance preferred.


  1. Knowledge of principles and processes for providing excellent customer service.
  2. Understanding of Intake and Financial Eligibility paperwork, and Arizona Department of Behavioral Health and Community Partnership of Southern Arizona admission/ Intake policies and procedures.
  3. Familiarity with a variety of computer software used for researching, tracking, data entry/processing, and reporting information, i.e. AHCCCS, PACE, Excel, Word, PowerPoint and various statistical or graphics programs.
  4. Knowledge of medical records standards and current statutes pertaining to member medical records.
  5. Knowledge of benefits eligibility standards and processes.
  6. Knowledge of administrative/clerical procedures and office equipment.
  7. Ability to assess and resolve complex aspects of membership operations.
  8. Ability to evaluate facts or situations to determine appropriate action.
  9. Ability to follow written and oral instructions, and to communicate effectively both orally and in writing.
  10. Ability to establish and maintain effective working relationships with staff, providers, members, funding sources and other agencies.
  11. Ability to maintain confidentiality and comply with HIPAA standards.
  12. Familiarity with various diverse ethnic and cultural groups.