Enrollment Representative I
Reference Code: 5087
Position Title: Enrollment Representative I, 17294-1
Location: Los Angeles/Orange County 90070
Duration: 3 months contract with possible extension
Comments for Suppliers:
Remote position, however candidate must be local to Los Angeles/Orange County area. Position will transition into onsite role once offices reopen.
Must have demonstrated experience working in a high production/fast-paced environment
Data entry experience needed
Very comfortable within the Microsoft Office Suite
What are the must have requirements for the position?
o The rep should have some experience in enrollments for Medicaid, Medicare, Marketplace and/or Commercial
o Data entry experience
o Experience within a fast-paced environment
o Microsoft Suite Knowledge (Word, Excel, PowerPoint, etc. )
o Good verbal and written communications skills.
o Flexible with schedule
o Internet Access
o Able to work from home and flex to work from the office as needed.
o Able to work OT if needed
o Ability to take direction from multiple Supervisors
o Must be able to work independently
What are the day to day responsibilities?
o Verify members eligibility and update as needed
o Update members Primary Care Physician assignments
o Document transaction in database
o Track daily tasks completed
o Phone calls to Commercial carriers to verify medical coverage
What are the daily hours?
o Monday – Friday: (8:00am-4:30pm.)
o Flexibility is expected based on work load.
The temp assignment will be focused on the reduction of inventory in Claims Workflow, Mailboxes and Call Tracking for both WA and UT and will begin on working with the CA inventory. This assignment will include current backlog for Claims Workflow, Call Tracking and MMW.
In addition the agents will provide support for the iServe Tickets, Enrollment mailboxes that have urgent TATs, projects resulting from file errors and issue resolution
Summary: Serve as a liaison between its members and Providers. Ensure members receive a level of service that exceeds their expectations. Respond and resolve questions and problems from current/prospective members or their representatives, providers and other appropriate parties within expected standards.
Essential Functions: To assist in successfully completing the month-end processing of eligibility files when assigned. Duties include working error and exception reports in a timely manner. Ensure all members are assigned to the correct Practitioner. Process and create eligibility lists and exports (includes electronic, hard copy-paper and diskettes exports) when assigned. Validate membership enrollment for ID card vendor processing. Reach performance goals as follows (also reference Eligibility Unit Work Activity Standards); accurately process PCP transfers received during month end process and all retro PCP transfer requests. Accurately process HealthNet Eligibility Tracking Forms (ETFs) and PCP transfers. Accurately updated member eligibility in QNXT based on supplemental rosters received from DHS. Timely submission of all eligibility lists (exports and hard copy) to our Providers and Groups. Verification of eligibility to members, providers and practitioners. Participate as a team player by demonstrating support to peers, management and other departments goals. Attend meetings and training sessions as scheduled. Assist with training of new employees as needed. Work with internal and external Departments and Providers on complex eligibility issues and ensure timely resolution. Process all assigned tasks through Claims and COB tools timely to ensure compliance in TAT Standards.
Knowledge/Skills/Abilities: Strong communication skill. Knowledge of Managed Care Plans (Medi-Cal, Healthy Families and Medicare) Good Telephone Techniques Strong writing skills; previous experience preparing reports and charts; appropriate grammar usage Working knowledge of Microsoft Excel (at least Intermediate Level), Word and Access (desired) Ability to abide by policies Maintain regular attendance based on agreed-upon schedule Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Required Education: High School Diploma
Required Experience: 0-2 years of relevant experience