Job Description

Description:

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

Schedule : Monday- Friday 8:00 am- 8 Pm

Position Summary

• The Contractual Eligibility Consultant is responsible to research and validate enrollment information, process enrollment transactions, make outbound calls to enrollees and members to obtain required enrollment information, handle member inquires and participate in enrollment projects.
• The Contractual Eligibility Consultant will support training initiatives and work to resolve member inquires or concerns.
• This position is temporary starting around August 1st -December 31st, working the hours between 8am – 8pm.
• There can be a change in shift to include hours and days, within two-day notice.
• If inventory is high at the end of the contract December 31st there will be a possibility that the contract can be extended.

What you will do

• Handles physical documents and paper records to verify the eligibility of patients or members for healthcare services.

• Reviews paper forms, applications, or supporting documentation to gather and validate information such as insurance coverage, demographic data, and eligibility criteria.

• Organizes paper-based eligibility documents by creating and maintaining filing systems, ensuring proper document storage, and implementing strategies to improve accessibility and retrieval of information.

• Analyzes the paper-based information and documentation to determine the eligibility of patients or members for healthcare services.

• Performs manual data entry tasks to input eligibility information into relevant systems or databases.

• Ensures compliance with relevant healthcare regulations, policies, and industry standards in relation to paper-based eligibility operations to maintain patient confidentiality.

• Identifies opportunities to enhance the efficiency and accuracy of paper-based eligibility operations.

• Follows regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and personal development.

• Generates reports and analyzes data related to paper-based eligibility operations to help improve processes, address bottlenecks, and support decision-making.

Experience : Required Qualifications

• Meet Monthly Metrics at a team level: Critical quality 98.5%; weighted production 10 per hour
• Personal errors from the OMT, avoidable rejections, and found errors will be monitored by your supervisor. Consistent repetitive errors in these categories can lead to corrective action if no improvement is made.
• Participate in cross training on various products and platforms to ensure Enrollment metrics are met
• Meet Departmental attendance expectations of 0 occurrences or less from the contract timeframe of August 1st – December 31st
• Follow established processes and workflows for each department task
• Complete required mandatory trainings by required timeframes
• Demonstrate computer skills for Microsoft Office (Excel, Word, Teams, Office Outlook).
• Participation in trainings and meetings with the computer camera on.

Preferred Qualifications

•Effective organization skills and attention to detail.

•Maintain great working relationships with sound judgment and responsibility.

•Effective communications, organizational, and interpersonal skills.

•Demonstrated problem solving skills

•Demonstrate skills to use the call recoding system.

Education : High School or GED

• Onsite Requirements : Fully remote (never coming onsite)

Job Tags

Similar Jobs