Senior Representative, Enrollment (Remote)

Molina Healthcare•Long Beach, CA

5d•Remote

About The Position

JOB DESCRIPTION Job Summary Provides senior level support for member enrollment activities. Collaborates with internal and external partners - leveraging expertise and knowledge of enrollment function to resolve member enrollment/eligibility issues. Essential Job Duties Resolves eligibility issues including but not limited to: incoming/outgoing eligibility, primary care provider (PCP) assignment and member identification (ID) card processing. Verifies other member health insurance to establish primary and secondary payors in the system. Reconciles eligibility information with state or federal agencies using varied methods. Analyzes and assists with complex member eligibility issues, and provides resolution to internal partners, external client and regulators (Centers for Medicare and Medicaid Services (CMS), federal/state exchanges, etc.). Responds, documents, tracks and ensures quality for all proceedings with state and/or federal agencies (including member complaints) within required service level agreements (SLAs). Utilizes critical-thinking skills to proactively communicate eligibility issue trends to leadership. Manages high-volumes of tasks to support regulatory requirements, SLAs and competing priorities. Contributes to technical system enhancements by performing user testing related to enrollment. Demonstrates a team player approach - assisting peers and leadership to support enrollment department goals. Trains new staff on assignments and/or vendors on enrollment-related processes. Serves as subject matter expert (SME) to support enrollment production and provides knowledgeable responses to internal and external inquiries regarding member eligibility, ID cards, selection of PCP, and state enrollment transactions. Prioritizes daily, weekly and monthly job tasks to support enrollment-related regulatory requirements and SLAs. Supports enrollment-related special projects including regulatory audits. Facilitates member outreach for clarification or verification of enrollment applications. Resolves the following eligibility exceptions within the required state/regulatory timeframes: enrollment file errors, ID card generation errors, PCP assignments and 834 enrollment files to vendor/third party administrators. Performs enrollment functions to include: call tracking, claims workflow, and encounter requests for verification and updates, PCP assignment activity, enrollment record error reports, and enrollment/disenrollment activities. Displays initiative to complete assigned tasks timely and accurately and balances workload to assist peers and leadership team. Demonstrates strong knowledge of enrollment processing for federal, state, and business regulatory requirements with a strong system knowledge of internal and state portals, state reports, 834/SSRS, CMS and other Molina applications. Assists with complex enrollment issues concerning member eligibility. Facilitates quality reviews and submission of deliverables to government contracts team and state Medicaid agencies.

Requirements

At least 3 years of experience in health care, and/or customer/provider services experience, or equivalent combination of relevant education and experience.
Customer service experience.
Data processing and proofing experience.
Attention to detail, organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Responsibilities

Resolves eligibility issues including but not limited to: incoming/outgoing eligibility, primary care provider (PCP) assignment and member identification (ID) card processing.
Verifies other member health insurance to establish primary and secondary payors in the system.
Reconciles eligibility information with state or federal agencies using varied methods.
Analyzes and assists with complex member eligibility issues, and provides resolution to internal partners, external client and regulators (Centers for Medicare and Medicaid Services (CMS), federal/state exchanges, etc.).
Responds, documents, tracks and ensures quality for all proceedings with state and/or federal agencies (including member complaints) within required service level agreements (SLAs).
Utilizes critical-thinking skills to proactively communicate eligibility issue trends to leadership.
Manages high-volumes of tasks to support regulatory requirements, SLAs and competing priorities.
Contributes to technical system enhancements by performing user testing related to enrollment.
Demonstrates a team player approach - assisting peers and leadership to support enrollment department goals.
Trains new staff on assignments and/or vendors on enrollment-related processes.
Serves as subject matter expert (SME) to support enrollment production and provides knowledgeable responses to internal and external inquiries regarding member eligibility, ID cards, selection of PCP, and state enrollment transactions.
Prioritizes daily, weekly and monthly job tasks to support enrollment-related regulatory requirements and SLAs.
Supports enrollment-related special projects including regulatory audits.
Facilitates member outreach for clarification or verification of enrollment applications.
Resolves the following eligibility exceptions within the required state/regulatory timeframes: enrollment file errors, ID card generation errors, PCP assignments and 834 enrollment files to vendor/third party administrators.
Performs enrollment functions to include: call tracking, claims workflow, and encounter requests for verification and updates, PCP assignment activity, enrollment record error reports, and enrollment/disenrollment activities.
Displays initiative to complete assigned tasks timely and accurately and balances workload to assist peers and leadership team.
Demonstrates strong knowledge of enrollment processing for federal, state, and business regulatory requirements with a strong system knowledge of internal and state portals, state reports, 834/SSRS, CMS and other Molina applications.
Assists with complex enrollment issues concerning member eligibility.
Facilitates quality reviews and submission of deliverables to government contracts team and state Medicaid agencies.