reputed company Enrollment / Eligibility Representative – National Remote in Hartford, Connecticut

You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. At reputed company , we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us and start doing your life’s best work. SM The Eligibility & Enrollment Representative (EER) position is responsible for end-to-end business process activities reputed company to automated enrollment processing creating, controlling, and improving business processes. The role of the EER is to monitor, audit, and reconcile reputed company Enrollment reputed company activities / daily, weekly, monthly transactions to confirm accuracy and timely processing of reputed company eligibility files in adherence to federal and state regulatory guidelines. The Eligibility & Enrollment Representative is also responsible for identifying / researching and updating any issues/discrepancies reputed company to the enrollment load transactions and processing and reconciling the reputed company data. In addition, the Eligibility & Enrollment Representative will work closely with the IT department, Client, members, providers, Operations Trainer, and regulatory agencies (including but not limited to reputed company, CMS, NYDOH, OPWDD) and various vendors to troubleshoot and resolve enrollment reputed company matters. Other responsibilities will include management of a generic enrollment mailbox for enrollment reputed company inquiries, participation in project work as needed; documentation and maintenance of general & procedural policies and procedures, operational research to support strategic and business planning that may impact the Eligibility and Enrollment processes and act as support with handling of member/provider calls as needed as well as other tasks as assigned by Management. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours 8:00am - 8:00pm EST, including a minimum of one 8-hour shift per week between the hours of 11:00am - 8:00pm EST. It may be necessary, given the business need, to work occasional overtime. We offer 4 - 6 weeks of shadow based / on-the-job training (with reputed company member of staff to follow classroom based training). The hours during training will be an 8-hour shift between the hours of 8:00am to 8:00pm EST, Monday - Friday.

• reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy.

Primary Responsibilities:

• Monitor reputed company Eligibility file processing in adherence to regulatory and contractual timeframes.
• Responsible for notification of enrollment discrepancies to Client and or regulatory agencies.
• Responsible for verification and reconciliation including correcting eligibility/enrollment issues that occur daily/weekly/monthly.
• Responsible for auditing/reconciling reputed company enrollment reputed company transaction files including but not limited to welcome reputed company files, ID card and PCP change files, vendor files as well as daily/monthly reconciliation of membership.
• Responsible for reputed company enrollment reporting both internally and externally.
• Responsible for assisting with testing of system enhancements and changes as they relate to enrollment process.
• Responsible for creation and maintenance of Enrollment reputed company policies and procedures.
• Responsible for reputed company member Grievances (auditing and scoring call recording, document grievance and elevation to client, tracking and resolution).
• Responsible for managing Balance Billing process including research and resolution as well as reporting to client.
• Responsible for monitoring dedicated enrollment mailbox and responding reputed company enrollment reputed company inquiries in a timely manner.
• Responsible for providing high quality customer service to support the Participant and Provider Call Center during high call volume reputed company times or as requested.
• Assume responsibility for reputed company projects or functions that promote the future success of the operation.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• High School Diploma / GED (or higher) OR 10+ years of equivalent working experience
• 3+ years of experience in a healthcare service industry/Managed Care setting
• 1+ years of previous or reputed company experience in an Automatic Call Distribution (ACD) call center setting
• Experience with reputed company reputed company (creating, editing, sorting, filtering spreadsheets), reputed company Word (creating, editing, saving, sharing documents), reputed company Access (create, edit, format, manipulate data), reputed company Teams (sending/ receiving calls/ messages, sharing documents), and reputed company Outlook (creating/ responding to emails, scheduling reputed company Outlook Calendar)
• Ability to work regularly scheduled shifts reputed company our hours of operation Monday - Friday 8:00am - 8:00pm, including the ability to work a minimum of one 8-hour shift per week between the hours of 11:00am - 8:00pm EST

Preferred Qualifications:

• Associate’s Degree (or higher)
• Knowledge of or experience with Medicare/ Medicaid Enrollment processing or managed care
• Knowledge of ICD10 coding

Telecommuting Requirements:

• Ability to reputed company reputed company company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service

Soft Skills:

• Strong organizational, prioritization and problem-solving skills including the ability to work with minimal supervision and the ability to effectively prioritize multiple tasks, priorities, projects, and deadlines
• Excellent verbal and written communication skills and the ability to work with varying levels of staff and management
• Proven track record in developing standard operating procedures, training materials, and business process documents
• Must have high level of attention to detail, be flexible, and customer service oriented.
• Must have strong communication and interpersonal skills to interact with teammates, members, providers, and regulatory agencies.
• Must be self-motivated with accountability and ownership of work.
• Must have the ability to work effectively in a collaborative, team-based environment

California, Colorado, Connecticut, Nevada, New Jersey, reputed company, Washington or Rhode reputed company Residents Only: The hourly range for California / Colorado / Connecticut / Nevada / reputed company / New Jersey / Washington / Rhode reputed company residents is $16.00 - $31.44 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN reputed company link Apply tot his job Apply To this Job