Billing, Claims Processing, Communication Skills, Cross-Functional, Data Entry, Data Processing, Detail Oriented, File Maintenance, Health Maintenance Organization (HMO), Health Plan, Healthcare, Hewlett-Packard Product Family, High School Diploma, Information Technology & Information Systems, Insurance, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Word, Organizational Skills, Problem Solving Skills, Process Improvement, Purchasing/Procurement, Reconciliation, Reporting Skills, Spreadsheets, Team Player, Time Management, Training/Teaching, Writing Skills
Under direct supervision, is responsible for a variety of specific functions associated with enrollment and reconciliation transactions to facilitate accurate enrollment data. He/she processes enrollment data within a timeframe and at a performance level that ensures members timely access to benefits and accurate processing of claims. He/she will compile the eligibility discrepancies in a timely manner to ensure that members are able to obtain health services appropriately. He/she also works collaboratively with various internal departments to resolve complex issues related to member eligibility and provider discrepancies to meet the Mission, Vision and Values of Neighborhood.
Duties and Responsibilities
Responsibilities may include, but are not limited to, the following:
- Maintain membership eligibility information in system
- Generate membership correspondence
- Produce enrollment activity reports for internal and external customers
- Interact with internal and external contacts regarding membership and eligibility issues
- Reporting and billing of births
- Manual data entry of newborns, exception reports and daily spreadsheets
- Provide enrollment information to internal customers about enrollment issues
- Act as secondary contact in communicating with EOHHS, HP, DCYF and/or HSRI to resolve enrollment issues
- Communicate to the Member Services department the status of enrollment processes
- Support and work collaboratively with the next level analysts in handling some tasks related to Coordination of Benefits, including research, outreach and reporting
- Provide back up to the next level analysts in a limited scope
- Maintaining absolute file integrity with regards to content, location and confidentiality
- Participate in training and development
- Identify opportunities for process improvements and workflow efficiencies
- Other duties as assigned
Qualifications Required:
- High School Degree or equivalent
- Three (3) years' HMO/insurance experience in member service/enrollment
- Communication skills, including excellent writing abilities
- Intermediate skills in Microsoft Office (Word, Excel, Outlook)
- Organizational skills and reporting experience
- Ability to work independently and as a team player
- Strong attention to detail and problem solving skills
- Ability to handle multiple responsibilities simultaneously
- Ability to work cross-functionally across different departments within the organization
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
N
Neighborhood Health Plan of Rhode Island
Neighborhood's employees come from a diverse background but all are committed to creating a more equitable health care system. Our array of experiences allows us to have a broad perspective and great creativity in facing whatever challenges arise. Unlike many other health insurance companies, we have nearly 30 nurses and social workers on staff. This structure speaks to our focus on active and compassionate care management for our members; we know that people who are alienated from the health care system require additional advocacy, outreach and support.
Neighborhood offers an exceptional compensation package to employees. We annually review base salaries/benefits and adjust as appropriate.