Coordinator, Eligibility

Navitus Health Solutions, LLC

1d•Remote

About The Position

Navitus Health Solutions is seeking a Coordinator, Eligibility to join our team! The Coordinator, Eligibility ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. The Coordinator, Eligibility will work closely with Information Technology, Benefit Configuration, Implementation, and Account Management teams to understand the interdependences of each functional area. The Coordinator, Eligibility is responsible for the ongoing management of client eligibility processes and will function as the lead eligibility resource for assigned clients, as well as a back-up resource for peer coordinators when needed. The Coordinator, Eligibility will have direct authority to make sound business decisions regarding client eligibility data and will demonstrate the ability to continually prioritize day to day workload to meet individual, departmental, and organizational goals. This position may include after-hour and/or weekend hours depending on workload. This position also includes after-hour and weekend on-call duties on a rotating basis with other team members. Is this you? Find out more below!

Requirements

Associate’s degree or equivalent work experience required.
Minimal experience and/or training to begin learning skills, systems, and processes of the role with ability to perform tasks with close supervision.
Basic experience with Microsoft Office, specifically Word and Excel.
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Responsibilities

Oversees, manages, and maintains eligibility data, processes, and services for clients of low to moderate complexity. This includes understanding client needs, monitoring electronic file loads and subsequent reports, ID card/booklet generation, reconciliation reporting, implementation activities and any additional eligibility related processes.
Performs urgent eligibility additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
Collaborates directly with client and/or Account Management team to report data file errors and eligibility reconciliation results on an agreed upon client schedule.
Participates in existing client changes and audits, acting as the representative for eligibility data in all related meetings and communications.
Uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies.
Conducts system enhancement and regression testing of a low to moderate level of complexity for eligibility related processes to ensure compliance with state, federal and client regulations/standards.
Generates queries and reports to monitor membership and identify/troubleshoot issues.
Other duties as assigned.