Eligibility Specialist
About The Position
Provides support to the Eligibility Supervisor in all aspects of customer service, account management, and administrative projects. This role acts as a partnership within the eligibility department, assisting with the maintenance of eligibility, EOBs, DMRs, ID card printing and maintenance, and other assigned tasks. The position involves resolving incoming eligibility-related issues through various communication channels, performing eligibility duties including processing and maintaining daily/weekly eligibility files, and assisting with monthly reporting and audits. It also requires monitoring fallout and threshold reports, collaborating with BI and other operational teams, providing Help Desk support for customer service issues, and assisting with new client implementations and on-site client support. Office duties and mandatory training are also part of the responsibilities.
Requirements
- 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
- Provide support to the Eligibility Supervisor for customer service, account management, and administrative projects.
- Act as an eligibility department partner to resolve incoming eligibility-related issues via email, IT tickets, phone, and meetings.
- Perform eligibility duties, including processing and maintaining daily/weekly eligibility files.
- Assist in the monthly distribution of daily, monthly, and quarterly reporting, including census reports.
- Provide support for the bi-weekly and/or monthly eligibility audit process.
- Monitor and respond to daily fallout reports and threshold reporting.
- Partner with BI for escalated items and data management collaboration.
- Collaborate with other operational teams such as Implementation, Benefit Review, BOM, Clinical, ProActPlus, Account Management, and Account Coordinators.
- Provide Help Desk ACD phone coverage for incoming calls and direct them to appropriate staff.
- Resolve customer service issues to ensure client satisfaction.
- Perform DMR and EOB duties to ensure client satisfaction.
- Assist with the coordination and implementation for new clients and TPA partners, including 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.
- Perform general office duties such as copying, collating, mailings, and filing.
- Complete all mandatory and regulatory training programs.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
