What are the responsibilities and job description for the Enrollment & Billing Processor I - Health First Health Plan, Hybrid Remote/Onsite position at Health First?
POSITION SUMMARY
Accountable for evaluating applications for errors or missing information, activating, changing or terminating coverage for members based on the request provided. Perform basic core system actions. Responsible for maintaining the member eligibility status and triggering correspondence to the members as needed.
PRIMARY ACCOUNTABILITIES
1. Review and interpret member or group contracts as they pertain to an enrollment transaction.
2. Evaluate and process enrollment information in compliance with all regulations and contract terms.
3. Verify eligibility and settle the enrollment status, make changes to existing members based on eligibility guidelines including, processing dependent additions and deletions.
4. Generate customer correspondence and other fulfillment materials to members and groups as assigned.
5. Research eligibility and compile supporting documentation for further review by appropriate team members.
6. Provide outstanding customer service by researching and explaining the status of complicated eligibility requests to both internal and external customers.
7. Maintain confidentiality and follow departmental and organizational confidentiality guidelines.
8. Identify trends impacting members eligibility and enrollment status
9. Review and analyze data prior to updating the core system.
10. Meet all department timeliness and quality expectation requirements.
Qualification:
MINIMUM QUALIFICATIONS
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o Intermediate skills in essential Microsoft Office applications especially Excel & Word
o Ability to perform basic core system actions
o Basic knowledge of Federal, State, CMS guidelines, statutes, and regulations as they pertain to Health Insurance
o Basic ability to interpret commercial and government contracts
o Critical thinking and attention to detail
o Demonstrate problem solving skills
o Ability to build relationships and communicate effectively
o Excellent oral and written communication skills
PREFERRED QUALIFICATIONS
Sedentary – Office Workers
Accountable for evaluating applications for errors or missing information, activating, changing or terminating coverage for members based on the request provided. Perform basic core system actions. Responsible for maintaining the member eligibility status and triggering correspondence to the members as needed.
PRIMARY ACCOUNTABILITIES
1. Review and interpret member or group contracts as they pertain to an enrollment transaction.
2. Evaluate and process enrollment information in compliance with all regulations and contract terms.
3. Verify eligibility and settle the enrollment status, make changes to existing members based on eligibility guidelines including, processing dependent additions and deletions.
4. Generate customer correspondence and other fulfillment materials to members and groups as assigned.
5. Research eligibility and compile supporting documentation for further review by appropriate team members.
6. Provide outstanding customer service by researching and explaining the status of complicated eligibility requests to both internal and external customers.
7. Maintain confidentiality and follow departmental and organizational confidentiality guidelines.
8. Identify trends impacting members eligibility and enrollment status
9. Review and analyze data prior to updating the core system.
10. Meet all department timeliness and quality expectation requirements.
Qualification:
MINIMUM QUALIFICATIONS
- Education\: High School diploma or GED
- Licensure\: None Required
- Certification\: None Required
- Work Experience\: 1 year experience working in an administrative function for a health care institution
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- Knowledge/Skills/Abilities\:
o Intermediate skills in essential Microsoft Office applications especially Excel & Word
o Ability to perform basic core system actions
o Basic knowledge of Federal, State, CMS guidelines, statutes, and regulations as they pertain to Health Insurance
o Basic ability to interpret commercial and government contracts
o Critical thinking and attention to detail
o Demonstrate problem solving skills
o Ability to build relationships and communicate effectively
o Excellent oral and written communication skills
PREFERRED QUALIFICATIONS
- Education\: Associates Degree
- Licensure\: No additional required
- Work Experience\: 1 year experience in healthcare insurance and or customer service
- Knowledge/Skills/Abilities\: Experience using Amisys or Market Prominence systems
Sedentary – Office Workers
- Sedentary work involves sitting most of the time
- Walking and standing or lifting more than 10 pounds are required only occasionally
- Must be able to tolerate long periods of computer time a day
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