Eligibility Coordinator - SCAN Temp

SCAN Health Plan • Long Beach, CA

1d • Remote

About The Position

The Eligibility Coordinator - SCAN Temp will maintain SCAN Health Plan's core eligibility system by reconciling, entering, correcting, and deleting member information. This role involves processing member applications, researching eligibility rejections, and entering member data into the IKA system. The coordinator will ensure regulatory compliance, verify eligibility using state and Federal websites, and assist coworkers. A key part of the role includes providing excellent customer service through outbound calls to members to clarify and confirm information for enrollment. The position also requires representing the department in meetings and process improvement teams, maintaining knowledge of eligibility and CMS regulations, and responding to customer inquiries. Additionally, the role involves preparing eligibility reports and member correspondence, reconciling data from regulatory systems, and resolving member eligibility issues through daily reconciliations. The company is seeking individuals who are curious about AI and its potential to transform operations and member service, and who will actively support SCAN's vision and goals. Other duties as assigned.

Requirements

• High School Diploma or equivalent experience required.
• 0-3 years of related experience.
• Performs work under minimal supervision.
• Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
• Possesses comprehensive knowledge of subject matter.
• Provides leadership, coaching, and/or mentoring to a subordinate group.
• May act as a lead or first-level supervisor.
• Technical expertise - Basic technical skills for functional area.
• MS Office - Word, Excel, Outlook, Teams, PowerPoint experience required.
• Problem Solving - Basic problem solving skills.
• Communication - Good verbal and written communication and interpersonal skills.
• A background check is required.

Nice To Haves

• Curious about AI and its power to transform how we operate and serve our members.

Responsibilities

• Processes member applications by reviewing data for deficiencies; assigning codes to data; establishing data entry priorities, and resolving discrepancies by using departmental policies and procedures.
• Research eligibility rejected transactions by identifying discrepancies and report findings to the appropriate business area.
• Enter member data by inputting alphabetic and numeric information into IKA system according to screen format including benefit assignment, group affiliation, and provider selection, billing information, revenue codes and appropriate cross references.
• Ensure regulatory compliance by following departmental desktops, policies and procedures, by adhering to state and Federal regulations and requirements.
• Verify eligibility for enrollment using state and Federal websites.
• Assist co-workers by training, updating processes, and assisting with job duties.
• Provide excellent customer services by making a high volume of outbound calls to members to clarify, obtain, and or confirm information needed to successfully complete member’s enrollment request.
• Represent the department by attending meetings, trainings, and process improvement teams.
• The ability to accurately interpret and explain eligibility and CMS regulations and requirements in person, via email or telephonically.
• Complete requests received through Enterprise, Department Inbox, and Department Queue by responding appropriately and in a timely fashion to internal and external customers; by answering telephonic and written inquiries concerning eligibility issues; following department policies and procedures; by professionally representing the department to others.
• Maintain professional and technical knowledge by utilizing access to SCAN University on-line trainings, attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Prepare eligibility report mailings by generating, reviewing and distributing eligibility information to providers within defined timelines.
• Contribute to team effort by accomplishing related results as needed.
• Prepare member correspondence by creating, triggering, printing, reviewing and mailing.
• Assure accurate data from regulatory system reply by utilizing Federal systems and other departmental systems to run reports and collect and analyze data for any necessary updates.
• Responsible for daily reconciliations, in an effort to resolve member eligibility Issues by analyzing, correcting or updating data received on daily claims error report, unassigned PCP list and Incomplete Queue.
• Reconcile discrepancies, between member data and various systems.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• Medical Benefits
• Paid Sick Time
• Excellent 401(k) Retirement Saving Plan
• Robust employee recognition program
• An opportunity to become part of a team that makes a difference to our members and our community every day!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED