37386950
Title: Client Call Center Eligibility Spc
Location Fort Worth 76104
Pay : 35-40/HR on W2
Duties: Job Summary:
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 CCHP Programs and can effectively use closing skills, troubleshoot, resolve problems and provide a positive customer experience.
Job 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 CCHP 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 CCHP staff.
-This includes any issues with CCHPs 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. null
Skills: Required Skills & Experience:
-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 Cook Children's Health Plan 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). No testing requirement. null
Keywords:
Education: Required Education:
-High School Diploma or GED.
kindly share resume with answers;
Q1: How many years of experience do you have working in a healthcare or health plan environment?
Q2: Have you worked with a Managed Care Organization (MCO), health insurance company, or health plan?
Q3: Describe your experience with member eligibility verification or enrollment.