SHSMD Career Center
Raleigh, North Carolina
Renton, Washington
Durham, North Carolina
Durham, North Carolina
Posted: 07-Mar-23
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 10914502
Summary:
The Health Plan Enrollment Representative will prioritize and coordinate daily tasks and projects. The Enrollment staff ensures that all data entry is accurate including demographic and financial information for each account. This position's core responsibilities include, but are not limited to enrolling new members, update existing members, review/update eligibility, and disenroll members in the appropriate applications. This associate will be responsible for researching complex problems using available resources and implementing solutions to mitigate any future issues. This position will be responsible for working various work queues, and other duties as assigned. The core responsibilities will be aligned with the timely and accurate entry of all phases of the enrollment/billing process for an exceptional level of service to our members. This position requires professional appearance, behavior, and good communication skills. Enrollment Representatives require dependability, flexibility, and teamwork.
- Accurately inputs all required data elements for scheduling and registration, including member demographic, financial information, and relevant notes associated with the encounter.
- Calculates and collects the estimated member portion based on benefits and contract reimbursement as well as prior balances.
- Represents the Enrollment department in a professional, courteous manner at ALL times.
- Supports the department in achieving established performance targets.
- Demonstrates contribution and achievement of department collection initiatives.
- Maintain confidentiality for all customers.
- Enrollment activities for members via paper, file transfer, or internet enrollment processing
- Maintain knowledge and expertise in eligibility, enrollment and billing; and program specifications for U.S. Family Health Plan, Medicare, Medicaid, and or the Federal marketplace.
- Maintain detailed tracking of each function within the enrollment and disenrollment process including correspondence and accuracy of member ID cards.
- Communicates verbally and in writing with members, third parties and other departments as required to facilitate the enrollment, disenrollment and billing processes.
- Responds to internal and external customer inquiries regarding eligibility and related functions.
- Enters information during the enrollment process that assists claims personnel in claim adjudication including COB.
- Consistently meets or exceed department and company standards and expectations including but not limited to quality, productivity and attendance.
- Responsible for member correspondences.
- Perform other duties as assigned
Requirements:
- High School Diploma
Work Type:
Full Time
