Description
POSITION SUMMARY Under the supervision of the Eligibility Manager, this position will provide efficient and timely processing of project request. The associate will prioritize and coordinate task and projects. This positions core responsibilities include, pulling eligibility data for regulatory reporting requirements, analyzing eligibility data, and working creating statistical reports for the Eligibility Quality Auditors. This positions core responsibilities include, but are not limited to obtaining a Common Access Card to enroll new members, update existing members, process/update payments, review/update eligibility, and disenroll members in the Defense Enrollment Eligibility Reporting System (DEERS) which is issued by the Department of Defense. This position will be responsible for working various workgroup queues, and other duties as assigned. The core responsibilities will be aligned with the timely and accurate entry of all phases of the enrollment process and coordination/communication across departments, internal and external customers, for an exceptional level of service to our members. MAJOR RESPONSIBILITIES- Provide application assistance and facilitate enrollment of eligible members and community members health insurance programs
- Maintain knowledge and expertise in eligibility, enrollment, and program specifications for U.S. Family Health Plan, Medicare, Medicaid, and the Federal marketplace
- Enrollment activities for members via paper, file transfer, or internet enrollment processing
- Consistently meet and exceed Service Level Agreements related to enrollment and disenrollment process
- Maintain detailed tracking of each function within the enrollment and disenrollment process including correspondence and accuracy of member ID cards
- Communicates verbally and in writing with members, third parties and other departments as required to facilitate the enrollment, disenrollment and billing processes
- Responds to internal and external customer inquiries regarding eligibility and related functions
- Enters information during the enrollment process that assists claims personnel in claim adjudication including COB
- Performs reconciliation
- Receives and works with incoming eligibility from a variety of sources
- Consistently meets or exceed department and company standards and expectations including but not limited to quality, productivity and attendance
- Provide vendor assistance
- Maintain confidentiality for all customers
- Attend management meetings when applicable in place of Eligibility Manager
Requirements
POSITION QUALIFICATIONSA. Education/Skills: - Analytic ability to organize and prioritize work to meet deadlines
- Strong computer application skills including Microsoft Word, Excel and Visio
- Excellent written and verbal skills required
- Good judgment, initiative and problem solving abilities
- Ability to handle and resolve complex issues with little assistance
- Ability to perform multiple tasks simultaneously
- Ability to communicate effectively
- Experience with SQL, Microstrategies, Microsoft Project
B. Experience - Three years healthcare experience with Managed Care experience preferred
C. Licenses, Registrations, or Certifications: - Driver's License
- Common Access Card (CAC) -- Requires the complications of a Public Trust Background check, Fingerprint Check, and Credit Check
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