Coordinator II-Eligibility Consultant–Paper Ops

Description:
Candidates can be located anywhere in the US, but pref. EST and CST.

Work Location: Fully remote (US-based)
Schedule: MondayFriday, 8:00 AM4:30 PM EST
Must work EST hours (preference given to EST-aligned candidates)
Safety Sensitive: Yes
Hiring Process: Hiring Managers have hired directly off resumes in the past, subject to change

Remote Work Requirements
Private, dedicated workspace: Required
Screenshot of internet speed: Required at submission

Top of Resume Candidate Screening Questions:
(Candidates must include these answered at the top of their resume)
Do you have experience verifying member enrollment or updating eligibility information (demographics, dates, plan changes)
Have you worked with manual enrollment updates or corrections in a healthcare system (ex: QNXT or similar)
Do you have experience researching and resolving eligibility or enrollment discrepancies using reports or reconciliation files
Have you handled enrollment requests or urgent updates received via email from health plans or state agencies
Do you have experience working claim'related inquiries tied to eligibility issues (ex: H03s or similar)
Are you familiar with Medicaid, Medicare, or Managed Care Organizations (MCOs)
Have you performed high'volume manual data entry where attention to detail and accuracy were critical
Do you have strong experience researching data issues and determining appropriate corrections independently
Are you comfortable learning and working across multiple systems and using Excel for tracking or analysis
Are you able to adapt to changing priorities and understand how your work impacts downstream teams and processes

Position Summary:
We are looking for a detail oriented individual to join Medicare PCP Enrollment Validation Team.
Plan Sponsor Service Consultants (PSSC) support PCP and CSNP processes.
PSSC's are required to perform multi-system research, make outbound calls and process provider updates for new and existing members.
Key responsibilities include provider validation and alignment to our Medicare members, as well as outreach to obtain Verification of Chronic Condition.
The PSSC must be able to meet the demands of a high paced environment with tight turnaround times while maintaining quality metrics.
Our team is member centric and strives to provide excellent customer service to our members.
The PSSC will work collectively with teammates, leadership and other departments as needed in their role.

Preferred Qualifications
1-2 years of experience working with members and/or providers.
Basic healthcare background.
Previous knowledge of provider networks.
Outbound call experience.
Candidate must be proficient in Outlook, MS Excel and Word.
Excellent Communication Skills.
Experience working in a team setting

Duties
Develop fixture and merchandise layouts that accurately reflect required product mix based on store location and clientele. Includes identifying stores within a growing number of cluster definitions (i.e., ethnicity, affluence, geography, etc.) that ultimately drive automated product replenishment. Independently prioritize and manage scheduled assignments to insure on-time project completion. Analyze, prioritize and summarize data, and compare to company standards in such a way that identifies opportunities on a store specific basis. Interact with Regional Sales Manager to confirm store specific analysis (e.g., sales, competition, ethnicity of clientele, etc.) in an effort to maximize individual store profit; and to confirm product mix, category adjacency and service issues as they relate to customer needs. Support corporate expense control by managing the impact of layout changes relative to established budget guidelines. Advocate alternative approaches, as needed, and communicate incremental scope of work and added cost to field management and project partners. Work with the Construction team and outside vendor architects to develop innovative merchandising solutions for atypical store locations.

Experience
Required Qualifications
High School Diploma, GED or Equivalent.

Preferred Qualifications
1-2 years of experience working with members and/or providers.
Basic healthcare background.
Previous knowledge of provider networks.
Outbound call experience.
Candidate must be proficient in Outlook, MS Excel and Word.
Excellent Communication Skills.
Experience working in a team setting

Education
High School Diploma, GED or Equivalent

Position Summary
We are looking for a detail oriented individual to join Medicare PCP Enrollment Validation Team. Plan Sponsor Service Consultants (PSSC) support PCP and CSNP processes.  PSSC's are required to perform multi-system research, make outbound calls and process provider updates for new and existing members.  Key responsibilities include provider validation and alignment to our Medicare members, as well as outreach to obtain Verification of Chronic Condition.  The PSSC must be able to meet the demands of a high paced environment with tight turnaround times while maintaining quality metrics. Our team is member centric and strives to provide excellent customer service to our members. The PSSC will work collectively with teammates, leadership and other departments as needed in their role.

Education
Verifiable High School diploma or GED required

What days & hours will the person work in this position List training hours, if different.
Mon-Fri 8:00am-4:30pm EST