Eligibility Consultant - Paper Ops

The Enrollment Representative position will be supporting multiple health plans. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.

Responds, researches, and resolves eligibility and/or billing related issues involving member specific information

Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.

Monitors daily status reports assessing output for developing trends potentially impacting service levels.

Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.

Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.

Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).

Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.

When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.

Interprets and translates client benefits and supporting account structure against internal systems/applications(i.e.,GEBAR, AAS, and CCI).

Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services.

Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.

Required Qualifications

Attention to detail and accuracy.

Problem solving skills.

Strong organization skills.

Understands the impact of work to other teams and downstream support areas.

Ability to analyze and research data to make appropriate corrections as necessary.

Strong verbal and written communication skills.

Workplace flexibility - ability to adapt to change.

Required to maintain work schedule within EST time zone (9:30am- 6:00pm EST).

Ability to remain available for overtime, with possible weekend work where needed.

Preferred Qualifications

Knowledge of Health Care and/or MCO’s.

Knowledge of Enrollment.

Knowledge Medicaid and/or Medicare.

Knowledge and comfortability with learning different systems and using Excel (VLOOKUP).

Education

High School Diploma or equivalent.