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Call Center Eligibility Specialist (Fort Worth, TX)

Paladin Consulting, Inc.

Fort Worth, TX

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JOB DETAILS
SKILLS
Call Centers, Competitive Research, Consulting, Customer Experience, Customer Support/Service, Data Analysis, Data Entry, Documentation, English Language, Fax Machines, Health Plan, Healthcare, High School Diploma, Identify Issues, Leadership, Managed Care, Multilingual, Presentation/Verbal Skills, Problem Solving Skills, Production Systems, Project/Program Management, Regulations, Reporting Dashboards, Retro, Spanish Language, Systems Maintenance, Time Management, Trend Analysis
LOCATION
Fort Worth, TX
POSTED
11 days ago
Paladin Consulting is currently hiring a Call Center Eligibility Specialist to join our team working onsite at our client's office located in Fort Worth, TX.

We work with companies that offer environments for our employees to contribute, learn, and advance their career. We treat you like you are part of the family.

Job Title: Call Center Eligibility Specialist
Work Location: Fort Worth, TX
Duration: 3 month contract
Shift: Mon - Fri 8am -5pm
Education/Experience Required: High School Diploma or GED; One (1) year of experience in health care setting & Two (2) years of experience working with data analysis and research.

Job Description :
  • Working under the direction of the Membership Data & Reporting Manager, is responsible for research requests for eligibility status/outcomes from health plan staff, Provider offices and Regulatory agencies in a timely and professional manner.
  • Identifies trends regarding issues with Member records and communicates them to Manager for research and resolution.
  • Operates in a fast-paced, production environment and takes ownership of their work product by understanding the value of timely and accurate eligibility research and system updates.
  • This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities and activities may change at any time with or without notice.
  • The Call Center Specialist will maximize the effectiveness of the staff by ensuring that representatives have a thorough knowledge and understanding of all Programs and can effectively use closing skills, troubleshoot, resolve problems and provide a positive customer experience.
Responsibilities :
  • 10% Demonstrates appropriate customer service skills such as active listening, courtesy, politeness, and helpfulness in order to maintain good working relationships with Members/Providers and all staff.
  • 15% Works any adhoc membership reports assigned by Manager using appropriate reporting dashboards.
    • Able to present reports to Call Center leadership. -Will complete these reports within the timeframe presented by leadership.
  • 20% Identifies any issues or trends that come across the eligibility files and communicates them immediately to Manager for quick resolution and communication to staff.
    • This includes any issues with core system that may impact Member records.
  • 25% Maintains the integrity of the core system by entering accurate information.
    • Aware that updating records has an impact downstream including the ability for Members to encounter access to care issues.
    • Uses extreme caution when modifying records.
  • 30% Works eligibility requests from different avenues (emails, faxes, EOBs) by researching eligibility and retro capitation adjustment files, and previous account notes. -
    • Makes appropriate and timely updates to Member records and documents the changes thoroughly. -
    • Will attach supporting documentation to the Member record.
Skills & Qualifications :
  • Required Education: High School Diploma or GED
  • One (1) year of experience in health care setting
  • Two (2) years of experience working with data analysis and research.
  • Will substitute for 1 year working within client's handling eligibility verification and research.
  • Familiar with Eligibility rules and guidelines within Managed Care Programs.
  • Required to work independently, manage multiple activities with competing timelines.
  • Demonstrated ability to make appropriate and accurate decisions.
Preferred Skills & Experience:
  • Data Analysis experience.
  • Fast and Accurate data entry. -Knowledge of state Managed Care Programs.
  • Able to work in a diverse environment and maintain cultural sensitivity.
  • Bi-lingual (English/Spanish).

For more information or to view other opportunities, visit us at www.paladininc.com.

Paladin Consulting is an EEOC employer.

About the Company

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Paladin Consulting, Inc.

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