What are the responsibilities and job description for the Electronic Eligibility Coordinator position at Corvesta Inc?
Position Summary:
The Electronic Eligibility (EE) Coordinator is responsible for the set up, testing, processing, and troubleshooting of electronic eligibility files for groups and vendors who require an electronic file feed. It is essential for the EE Coordinator to be proficient in communicating and working with a variety of internal stakeholders on a daily basis, including technical resources such as the Computer Room, Quality Assurance, and Business Systems Analysts along with external entities including new and existing customers and their respective technical teams in order to set up an automated process for loading of the external customer’s eligibility. The Electronic Eligibility Coordinator will often work directly with the group or work with a third party administrator with minimal oversight.
The Electronic Eligibility Coordinator constantly works in conjunction with IT resources to enhance the EE process and identify and solve issues that arise during the processing of files. The EE Coordinator must be knowledgable and skillful in performing their own research to determine causes when EE files fail, requiring exceptional attention to detail and knowledge around EE file field requirements and change thresholds. When errors are found, the EE Coordinator is responsible for communicating with both internal resources and outside group technical resources or vendors on what caused the file to fail and what may need to be corrected, and conduct subsequent bug fix testing.
The Electronic Eligibility Coordinator also provides support to the Sales and Account Management staff on a regular basis and whenever groups need to change account structure to communicate necessary process changes in loading and testing new files.
The Electronic Eligibility Coordinator will also be asked to perform other duties or work on special projects on an as needed basis.
Essential Functions:
- Process electronic eligibility files and work through all error reports on a daily and weekly basis. Must be able to meet or exceed client-determined performance guarantees around processing files.
- Establish and maintain accurate records of eligibility for new and existing enrollees through electronic processes.
- Process Client eligibility updates on a daily, weekly, monthly, quarterly and annual basis. Communicate with external technical resources regarding EE file layout requirements, and be able to answer questions accurately and independently.
- Reconcile and balance payments to the billed Accounts Receivable on the automated systems for selected accounts.
- Create all necessary financial adjustments to the automated system to reflect accurate Accounts Receivable for selected accounts.
- Communicate to the clients all issues identified through the Enrollment process, including downstream impacts based on benefit or account structure changes. Must be able to reach a mutual resolution to all open issues.
- Responsible for ensuring all documented processes and procedures are signed off on and followed when working with third party vendors to avoid PHI and/or PII disclosures.
- Answer telephone and written correspondence from clients regarding eligibility and billing questions.
- Represents Corvesta Services at Client sites as necessary.
- Review and correct claim eligibility issues related to EE groups.
- Completion of the automated End of Day processing.
- Develop test scenarios and accurately test for all system modifications to the electronic eligibility programs and procedures.
- Serve as a critical resource on technical project teams involving EE programs and procedures, including single-sign-on implementations.
- Create eligibility reports for electronically submitted group enrollment.
- Other duties as assigned to meet business needs
Qualifications/Education/Experience:
- Education and experience equivalent to a two-year college degree. Four-year degree preferred.
- Extensive knowledge of Applications within Microsoft Suite. Experience using technical issue tracking products such as JIRA is a plus.
- Must have excellent verbal and written communication skills with the ability to effectively communicate and interact with all levels of personnel and the general public.
- Prior experience in a computer programming, quality assurance, or business analyst role is desirable.
- Must possess good organizational skills and be able to handle multiple tasks with varying priorities.
- Demonstrated success applying Project Management skills such as facilitating kick-off calls, vendor management, risk mitigation, developing testing plans and ability to influence and get results through others.
- Comfortable making decisions and working on projects autonomously
- Ability to think and plan strategically for organizational success
- Strong interpersonal and communication skills
Physical Demands and Work Environment:
The physical demands and work environment characteristics 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.
- Physical demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. Use of hands is required for such technological devices such as a computer, telephone and others. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. The employee will be required to travel (sometimes long distances) to attend required meetings.
- Work environment: The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. The noise level in the work environment is usually minimal.
Delta Dental of Virginia is a drug-free work environment. Delta Dental provides equal opportunity in employment for all qualified persons and prohibits discrimination in employment on the basis of race, color, religion, creed, sex, sexual orientation, pregnancy and pregnancy related conditions, gender identity, national origin, ancestry, age, veteran status, disability unrelated to job requirements, genetic information, military service or other protected status.