Rancho Cordova, California
Eligibility Specialist II Job Opening in Rancho Cordova, California - ELIGIBILITY SPECIALIST
Job Description
Department:
Billing & Eligibility
FLSA Status:
Non-exempt
Industry : Healthcare Insurance
*This position is not with NTT Data Services. NTT Data Services is assisting a healthcare client with recruiting efforts.
About the company:
The company is a technology?driven health care risk management company, maximizing the value of data to deliver the most affordable health plans for employers.
Position Summary: The Eligibility Specialist is a key part of the department?s successful operation. The position reports to the Eligibility Supervisor. The Eligibility Specialist is in daily contact with members, clients, and providers, and therefore needs to be a cheerful, competent and compassionate representative of Company. The position is responsible to assess, interpret and process incoming eligibility feeds through all possible correspondence venues. This includes but is not limited to Cobra requests, Eligibility File Audits, Individual paper eligibility forms and all other potential eligibility inquiries and forms. Attendance can also directly impact the satisfaction level of our clients and retention of our accounts.
Essential Duties and Responsibilities: include the following. Other duties may be assigned.
Maintains all processes to stay compliant with the company?s contractual
Meets or exceeds all departmental metrics in regards to turnaround time, accuracy, and
Reviews Coordination of Benefits information to ensure proper reprocessing of
Coordinates and reviews incoming file loads under Supervisor
Maintains Flex Spending
Processes all incoming notices within 48 hours of receipt in accordance with the clients Plan Document and within the company?s procedures including but not limited to COBRA , Retroactive Terminations, and individual
Responds to incoming HealthX Inquiries within 24-48
Links Eligibility Document Information in
Processes any and all potential vendor eligibility
Communicates daily with the Supervisor regarding workload and potential
Notifies participant/client of any missing
Informs the Supervisor of any disputes, which may arise with a client, and any communication from an attorney or government
Coordinates billing processes with the Finance department to ensure timely and accurate
Advises the Supervisor of any computer problems in the claims processing software including any error message or the failure of the system to correctly process
Proactively seeks growth through the skill matrix and all available
Processes incoming eligibility requests in a timely fashion with 98% or better
Assists as needed or directed with other departments on an as needed basis.
Participates as a Team Member to ensure the smooth operation of the entire
Complies with company policies and procedures as outlined in the Employee
Complies with department policies and
Assists in training other employees at management?s
Performs special projects at the request of the Supervisor and Directors Answers all correspondence promptly and maintains correspondence files.
Regular, predictable attendance is
Ability to get along and work effectively with
Supervisory Responsibilities: This position has no supervisory responsibilities.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: Bachelor?s degree (B.A.) from four-year college or university; or minimum of three years relevant experience or related experience and/or training; or equivalent combination of education and experience.
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports, and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
Mathematical Skills: Ability to calculate figures and amounts such as discounts, interest, commissions and percentages. Ability to apply concepts of basic algebra and geometry.
Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills: To perform this job successfully, an individual should have knowledge of Internet software and the Microsoft Office Suite of products, Trizetto/RIMS eligibility programs and PBM software. Knowledge of basic office equipment should include: Internet and email, copy and fax machines, postage meter and telephone.
Physical and Emotional Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The inability to cope with a stressful work environment does not constitute a protected disability.
While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, and talk or hear. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually quiet.
An Equal Opportunity Employer
Job Type: Full-time
Salary: $15.00 to $17.00 /hour
Job Location:
Rancho Cordova, CA
Required education:
Bachelor's
Required experience:
Healthcare Inusurance: 3 years
Eligibility: 3 years
Billing/Accounting: 1 year
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