Are you looking to work for an organization that makes an impact in your community each and every day? At YourCare Health Plan we put our members first. We provide compassionate, high-touch care for individuals on government sponsored healthcare and support for the community-based partners who help them. At YourCare Health Plan, we focus exclusively on the safety-net population and we've been doing so for more than 45 years. We understand that our members face significant barriers and challenges to achieving good health. That's why we partner with community-based organizations that share our goal. We'd love to have you as part of our team.
Enrollment Processor
Grade: 206
POSITION SUMMARY
The Enrollment Processor (EP) accurately processes all Safety Net enrollment, disenrollment and status changes. This position is responsible for maintaining and documenting enrollment records for all Safety Net membership. The Enrollment Processor will provide a high level of customer service to all internal and external customers.
ESSENTIAL JOB DUTIES/FUNCTIONS
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% of Time
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Essential Function
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80%
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Eligibility:
- Accurately process eligibility requests, which includes but is not limited to: approval or denial of new member enrollments, disenrollment deletions, changes, and reactivations according to YourCare, State and Federal regulations.
- Research and resolve member eligibility inquiries from internal and/or external departments.
- Verify the validity of the application and supporting documentation and contact the member for resolution.
- Accurately research and/or investigate internal and external reports developed to ensure member eligibility verification and integrity of information. Utilizing NY enrollment sources and applicable tools to maintain integrity of data.
Coordination of Benefits:
- Investigate and resolve internal and external inquiries with regard to other insurance coverage and update the COB records and retract any applicable claims in the computer database.
Reporting:
- Import and export all electronic eligibility reporting according to Monroe Plan, State and Federal guidelines.
- Create and maintain eligibility reporting for specific groups and/or functions.
- Assist with identifying membership trends and prepare reports, as requested.
- Provide back-up coverage to the Enrollment Analyst when necessary.
Overall:
- Establish and verify product compliance to make sure quality standards are met and the organization's quality image is maintained or promoted.
- Store and maintain original documentation in compliance with Monroe Plan guidelines.
- Participate in YourCare, State and Federal audit activities.
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10%
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Department Operations:
- Assist in the development, documentation and implementation of operating policies and procedures.
- Communicate with internal and external customers regarding enrollment policies and procedures.
- Serve as liaison to other Monroe Plan departments and external customers to create/revise processes and procedures.
- Ensure adherence and continuous improvement with Monroe Plan enrollment policies and procedures.
- Assist with training new staff, as required.
- Represent department in interdepartmental meetings and task groups, as assigned.
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10%
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Administrative Assignments – Dependent on facility location
- Collection and documentation of payments received from member walk-ins
- Serve as back-up to the facility receptionist for breaks, lunch and vacations if business needs require.
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Total must equal 100% - essential functions should be completed at least 10% of the time
OTHER FUNCTIONS AND RESPONSIBILITIES
- Performs other duties as assigned.
- QNXT software experience
MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS
- Associate’s degree or equivalent
- 1-2 years’ experience in data entry and/or customer service /E&B and/or claims within a health plan or related field.
- Excellent data entry speed and accuracy
- Demonstrated strong analytical and problem solving skills
- Demonstrated organizational skills
- Ability to meet deadlines
- Ability to work in an autonomous work environment
- Excellent written and oral communication skills
- Basic computer skills
- Strong interpersonal skills; customer focused
PREFERRED QUALIFICATIONS
- Bachelor’s Degree in business-related or related field preferred
This job description is only a summary of the typical functions of the job, not an exhaustive or comprehensive list of all possible job responsibilities, tasks and duties. Additional responsibilities, tasks and duties may be assigned as necessary.
YourCare Health Plan is an Equal Opportunity Employer.
