Job Description
Job Summary:
The Enrollment Specialist II is responsible for reviewing files and interpreting data to enter members into eligibility systems according to appropriate regulatory guidelines.
Essential Functions:
Process work items according to appropriate regulatory guidelines
Review files and interpret the data to enter members into eligibility systems
Completion of daily change file pre-processor exceptions and monthly full file pre-processor exceptions
Research member eligibility and take appropriate actions to resolve issues across all eligibility systems
Process mass Primary Care Physician (PCP) changes with Provider Operations
Research, review, and interpret eligibility data to respond to eligibility inquiries from contracted vendors
Access state and federal government systems to review and confirm eligibility status
Process paper applications received for all applicable lines of business
Inbound phone coverage to answer inquiries from both internal and external customers
Complete all required corporate training within stated timelines to a satisfactory manner
Perform any other job duties as requested
Education and Experience:
High School Diploma or equivalent required
Associate's degree in accounting, finance or business related field or equivalent work experience is preferred
Minimum of two (2) years of healthcare, insurance, or related industry experience to include at least one (1) year of enrollment/eligibility or similar experience is required
Competencies, Knowledge and Skills:
Familiarity with Microsoft Word and Excel
Excellent verbal and written communication skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Knowledge of Medicaid and Medicare preferred
Critical listening and thinking skills
Proper grammar usage
Time management skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$40,400.00 - $64,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Hourly
Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
