Eligibility Specialist

KPH Healthcare Services • Gouverneur, NY

7d

About The Position

Provides support to the Eligibility Supervisor for all aspects of customer service, account management, and other administrative projects. This position acts as a partnership role within the eligibility department and assists in the maintenance of eligibility, EOB’s, DMR’s, ID card printing and maintenance, and other tasks as assigned.

Requirements

• Minimum: High School Diploma or GED

Nice To Haves

• 0-2 years experience as Rx Technician or Customer Service Representative in a health care related service.

Responsibilities

• Act as eligibility department partner; provide resolution for incoming eligibility related issues. To include email correspondence, IT tickets, ACD phone coverage, in person meetings, Team meetings and partner and/or client meetings.
• Perform eligibility duties, including the processing and maintenance of daily/weekly eligibility files.
• Assist in the monthly distribution of daily, monthly, and quarterly reporting including census reports.
• Provide support for bi-weekly and/or monthly eligibility audit process.
• Monitor and respond to daily fallout reports and threshold reporting.
• BI partnership for escalated items and tasks, as well as the day-to-day data management collaboration.
• Partnering with other operational teams such as Implementation, Benefit Review, BOM, Clinical, ProActPlus, and so on. Including the Account Management and Account Coordinator staff.
• Help Desk ACD phone coverage for incoming calls and directing incoming calls to appropriate staff members.
• Provide Help Desk resolution of customer service issues to ensure complete client satisfaction.
• Responsible for DMR and EOB duties to ensure complete client satisfaction.
• Assist with the coordination and implementation for the startup of new clients and new TPA partners to include new group enrollments, changes, and terminations.
• Assist with on-site client orientation, health fairs and business conferences.
• Assist with on-site resolution of customer service issues to clients.
• Performs office duties as needed (includes copying, collating, mailings, filing).
• Responsible for completing all mandatory and regulatory training programs.
• Perform other duties as assigned.

What This Job Offers

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