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Member Support Specialist (Medicaid)

Job Title
Member Support Specialist (Medicaid)
Job ID
Colorado Springs,  CO 80920
Other Location

Position Summary:  The Member Support Specialist will have extensive knowledge of local, community-based supports, to include social supports as well as medical and behavioral supports, in order to successfully connect members with existing health services and effectively navigate the health system.  The Member Support specialist will provide customer service for member inquiries, to include answering eligibility and enrollment questions, administering health needs assessments, identifying barriers and presenting solutions, and triaging patients to a higher level of care coordination, in order to assist members with maximizing their use of the health system.  The Member Support Specialist will provide customer service for physical and behavioral health provider inquiries, to include answering questions and connecting providers with available resources across the health system. 


COMPETENCIES/Role-Specific Functions: 


Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

  • Functions as a liaison between Health First Colorado members, health systems, medical providers and the CCHA Care Coordination Services call center in order to navigate through the medical home system of care.
  • Promotes communication among Health Partner I team
  • Participates in team meetings
  • Follows instructions



Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.

  • Triages incoming care coordination referrals by assessing level of urgency, reviewing and documenting needs, and determining appropriate level of care coordination
  • Effectively navigates resources in order to obtain information to answer member questions
  • Utilizes community resources appropriately



Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow.

  • Meets required inbound and outbound call statistics and documentation requirements



Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.

  • Takes initiative to identify business needs or training that will improve skillset
  • Collaborates with Health Partners to become an expert in CCHA care coordination services



Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

  • Develops strong telephonic relationships with members to include completing health risk assessments, educating members on proper use of the health care system, providing and/or arranging appropriate referrals to medical and non-medical services, and completing timely telephonic follow-up.



Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.

  • Conducts outbound calls to CCHA members in order to identify needs and connect with primary care services and/or higher level care coordination
  • Effectively uses computer software to document work
  • Keeps knowledge of Health First Colorado programs, CCHA programs, and community resources current
  • Maintain confidentiality and ensure compliance with HIPAA regulations.
  • Other duties as assigned.


Qualifications (Education/Experience/Knowledge/Skills/Abilities): 

  • Minimum of High School Diploma or GED; College degree preferred
  • Previous experience working in a health care setting preferred
  • One to three years’ experience with inbound or outbound calls in a healthcare setting
  • Working knowledge of basic medical terminology preferred
  • Bilingual (English/Spanish) preferred
  • Knowledge of care coordination and experience working with local community resources for medical and non-medical services.
  • Good verbal and written communication skills and the ability to convey information clearly
  • Good computer and internet skills required for data collection, data entry and reporting
  • Able to use Microsoft office
  • Able to identify and resolve problems in a timely manner and work well in a group and independent problem solving situations
  • Excellent time management skills and ability to complete tasks on time; able to multi-task

Physical Demands The physical demands described 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 regularly required to sit; use hands to finger, handle, or feel and talk or hear.  The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl.  The employee is occasionally required to climb or balance. The employee must regularly lift and/or move up to 25 pounds.  Specific vision abilities required by this job include close vision and ability to adjust focus.

Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The noise level in the work environment is usually moderate.