Eligibility Specialist

Title: Eligibility Representative

Assignment Length: Through 3/31/2025, extension/conversion pending performance, attendance, and business need.

Tentative Start Date: 8/5/2024, pending completion of interview and new hire onboarding

Schedule:

• Training Schedule: 8AMCST-5PMCST
• Ongoing Schedule: 6AM-2:30PM CST (Potential for OT)

*Must available to support the CST or EST schedules.

*Must have a quiet and private working environment with a high-speed, reliable internet connection.

Responsibilities:

Delivers basic technical, administrative, or operative Eligibility tasks. Implements and maintains eligibility for benefits. Implements, updates, and maintains automated, direct connect and/or manual eligibility data by keying information into the system. Interacts with internal partners and/or external clients/vendors. Analyzes data and reconciles eligibility for accuracy. Researches and resolves problems. Escalates difficult issues. Strong data entry and customer service skills. General product knowledge. Understands simple instructions and procedures. Performs Eligibility duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles.

• Responsible for determining plan eligibility and enrolling members within CMS regulatory guidance.
• Work to save members with incorrect/incomplete applications by performing customer, physician and/or agent outreach and using support tools. Maintain member demographic update and membership revalidation and apply eligibility requirements for membership changes.
• Research and respond to eligibility inquiries as needed.
• Ensures all enrollment eligibility is reconciled and maintained in accordance with CMS and departmental guidelines, requirements, regulations, policies, and procedures.
• This position involves reviewing incoming applications, keying information into systems, determining eligibility, and saving submissions as needed.
• Phone calls to potential customers and Medicaid systems will be made as needed throughout the day.
• In addition to phone calls, Medicaid websites will be reviewed to gather additional information and eligibility verification on enrollees.

TOP NON-NEGOTIABLE SKILLS

• Autonomous/Self-motivated Worker
• Analytical Thinker
• Available/willing to work OT as it will be mandatory during busy season

Other Skills

• 1-2 years of data entry and enrollment/eligibility experience highly preferred
• 1-2 years of healthcare experience required
• Experience with Medicare and state Medicaid highly preferred
• Candidates with enrollment or eligibility experience will take priority
• Proficient with Microsoft Office suite products
• Advanced PC Skills required
• Strong attention to detail
• Critical thinking
• Ability to work with minimal supervision
• Excellent verbal and written communication skills
• Strong Customer Service skills

Education:

• HS Diploma required