Eligibility ConsultantPrimary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix Apply
- Responds, researches, and resolves eligibility and/or billing related issues involving member specific information
- Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
- Monitors daily status reports assessing output for developing trends potentially impacting service levels.
- Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
- Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
- Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).
- Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
- When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI).
- Determines and communicates standard service charges to internal/external customers related to paper eligibility activities
- May include negotiating and communicating charges pertaining to non-standard services.
- Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.
- Medicaid Experience
- Data Entry Experience
- Attention to detail
- Customer Service
- Ability to analyze and research data to make appropriate corrections as necessary.
- Understands the impact of work to other teams and downstream support areas.
- Strong verbal and written communication skills.
- Strong organization skills.
- Problem solving skills.
- Attention to detail and accuracy.
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