Eligibility Screener and Operations Support

Magellan Health•Boise, ID

About The Position

This position works directly with members and non-members to ensure that they have access to assistance in completing eligibility and redetermination screenings in a timely manner. The role includes conducting eligibility screenings that determine eligibility for other state funding and GPRA assessments. This position will also support operations with other administrative functions that could support departments such as clinical operations, network, compliance, and quality. Manage the daily task lists in TruCare for eligibility screenings that need to be completed. Perform eligibility screenings to determine member eligibility for various state funding programs and administer Government Performance and Results Act (GPRA) assessments. Help facilitate appropriate referrals for members who no longer meet state eligibility requirements or other applicable programs. Manage lists generated from the Enrollment department to identify members at risk of losing coverage and provide outreach. Follow up on alerts regarding member eligibility issues, offering support and outreach to members and their families. Document all actions, including phone calls and member interactions, in the centralized record system in a timely manner. Make recommendations for policy and procedure improvements focused on member retention, workflow efficiencies, and member satisfaction. Submit help desks tickets for issues that may be needed due to requirements of the screening or when there are issues with the medical record system. Perform administrative functions, including phone calls, emails, or other communications that help support the operations of the organization. Demonstrate ability to meet performance metrics, including volume-based targets for calls, eligibility screenings, and surveys. Assist with managing Authorization to Use and Disclose (AUD) process. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Requirements

2+ years of relevant experience in the human services field required.
Proven ability to build relationships and collaborate with providers and members.
High level of accountability and responsibility for outcomes.
Excellent interpersonal, verbal, and written communication skills.
Strong problem-solving skills and creativity.
Proficiency with Microsoft Office products and ability to quickly learn new software applications.
GED, High School

Nice To Haves

Behavioral Health, Healthcare
Bachelor's

Responsibilities

Manage the daily task lists in TruCare for eligibility screenings that need to be completed.
Perform eligibility screenings to determine member eligibility for various state funding programs and administer Government Performance and Results Act (GPRA) assessments.
Help facilitate appropriate referrals for members who no longer meet state eligibility requirements or other applicable programs.
Manage lists generated from the Enrollment department to identify members at risk of losing coverage and provide outreach.
Follow up on alerts regarding member eligibility issues, offering support and outreach to members and their families.
Document all actions, including phone calls and member interactions, in the centralized record system in a timely manner.
Make recommendations for policy and procedure improvements focused on member retention, workflow efficiencies, and member satisfaction.
Submit help desks tickets for issues that may be needed due to requirements of the screening or when there are issues with the medical record system.
Perform administrative functions, including phone calls, emails, or other communications that help support the operations of the organization.
Demonstrate ability to meet performance metrics, including volume-based targets for calls, eligibility screenings, and surveys.
Assist with managing Authorization to Use and Disclose (AUD) process.