The Behavioral Health Membership Specialist serves as the primary access point for patients seeking Behavioral Health services. This role operates within a fast-paced, multi-disciplinary environment, handling inbound client communication, enrollment, appointment scheduling, insurance verification, and referral coordination. The specialist ensures timely access to care while maintaining accuracy, compliance with regulatory standards, and adherence to payer-specific requirements.
Key Responsibilities
- Serve as the first point of contact for prospective Behavioral Health clients, managing inbound calls and inquiries promptly and professionally
- Collect, verify, and maintain accurate patient eligibility and insurance information
- Validate primary, secondary, and tertiary insurance coverage using automated systems, payer portals, and direct communication with insurers
- Schedule intake appointments based on patient eligibility and provider availability/credentialing
- Process and track referrals and authorizations, ensuring timely approvals and follow-ups
- Review and interpret legal documentation (e.g., custody agreements, DCS requirements) to support proper enrollment
- Maintain accurate and detailed documentation in the EMR system, including eligibility, benefits, and communication logs
- Regularly re-verify insurance coverage and monitor authorization status to prevent care delays
- Serve as a resource for providers and staff on insurance eligibility, referral processes, and payer guidelines
- Notify clinical teams of insurance terminations, authorization expirations, or issues impacting patient care
- Support billing accuracy by providing guidance on coverage, co-pays, and authorized services
- Prioritize and escalate urgent requests to ensure continuity of care
- Ensure compliance with all federal, state, and organizational policies and procedures
- Maintain strict confidentiality of patient information and follow ethical standards
- Complete incident reports accurately and follow proper reporting protocols
- Participate in ongoing training, workshops, and professional development activities
- Collaborate effectively with internal teams to support a positive and productive work environment
- Perform additional duties as assigned
Qualifications
- High school diploma or equivalent
- Basic Life Support (BLS) certification (or ability to obtain upon hire)
- Fingerprint Clearance Card (Arizona Department of Public Safety)
- Valid Arizona driver's license with a clean driving record and current vehicle insurance
- Minimum of 1 year experience in a medical or behavioral health setting
- Working knowledge of health insurance plans, benefits, and verification processes
- Experience with Regional Behavioral Health Authority (RBHA) systems
- Familiarity with AHCCCS behavioral health billing
- Bilingual in Spanish
- Proficiency in Microsoft Office or similar tools
- Equivalent combinations of education and experience may be considered
Perks
- Permanent Work From Home
- Leave Credits
- Monetary Allowance
- Annual Bonus
- Weekly Paychecks
- Fixed Weekends Off
- Thriving Company Culture with Complete Autonomy
- Exclusive Specialized Training Programs
- Unlock Your Potential with a Highly Competitive Salary
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Who are we
MedCore Solutions is the healthcare division of BizForce, dedicated to supporting U.S.-based healthcare clients through a skilled remote workforce in the Philippines. We specialize in connecting top clinical and administrative talent with reputable healthcare organizations, ensuring high-quality care delivery while providing rewarding work-from-home careers.
