Eligibility Associate Representative

100% work at home
8:30am - 5:00pm EST (prefers candidates who live in EST & CST)
Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle reconciliation for non-standard requests. May provide technical support for the electronic procession of eligibility. Ensures customer data is installed accurately and timely. Technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision, but have ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues.
ESSENTIAL FUNCTIONS
Facilitates accurate processing of Enrollment applications to ensure timely input and acceptance to CMS.
Performs account benefit verification requiring complex decision skills based on payer and process knowledge resulting in proper access to care.
Process Reconciliation files from CMS to include Disenrollments, Late Enrollment Penalties and Low Income Subsidies
Timely and Accurate processing of monthly Premium payments including identification and processing of write offs, resolution of credit balances and posting of payments to member accounts
Process Coordination of Benefits and Medicare Secondary Payer files from CMS to meet Federal and State Regulatory guidelines.
Ensure accuracy of data entry to allow for meeting proper Service Level Agreements
Use discretion & independent judgement in handling more complex cases and be willing to learn new skills within the Enrollment Functions
Directly interfaces with other teams within ***
Provide support to other internal functions as needed.
May need to be proficient in Multiple Systems
Completes other projects and additional duties as assigned.

Top 3 Skills:
Analytical skills
Customer Service Skills
Quick Learner
Other Skills
Knowledge of CMS Enrollment & Reconciliation process
Knowledge of CMS Billing requirments and regulations
Knowledge in Coordination of Benefits and Medicare Secondary Payer
Medicare Part C and Part D
Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
Intermediate data entry skills and working knowledge of Microsoft Office.
Excellent presentation and communication skills.
Demonstrated ability to handle challenging interactions in a professional manner.
Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
SQL (a plus not required)

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