Hours/Schedule: Mon-Fri - 7:00am–4:00pm or 7:30am-4:00pm
Location: Remote - will be provided with PC, supplies, and training will be virtual with a live instructor.
This will be for enrollment/eligibility and benefits verification and updating (in Epic).
The Enrollment Coordinator position requires understanding of managed care systems and the importance of member eligibility/benefits as the foundation of the process. Effective communication skills and a working knowledge of managed care and health plan contracts are critical as are good judgment and decision-making skills. Strong interpersonal relations and team building skills are a requirement for internal and external purposes. Experience in managed care and processing enrollment is important.
- Responsible for processing member eligibility and benefits.
- Assists physicians, physician offices, vendors and health plans in verifying eligibility/benefits, answering enrollment questions and investigating enrollment problems.
- Follows up on outstanding issues to ensure completion.
- Verifies eligibility with health plans either by the internet or telephone.
- Determines Coordination of Benefits based on established industry guidelines.
- Works with the Claims, Referrals and Customer Relations Departments on any urgent enrollment issues so as not to interrupt patient care.
- Assists the Utilization Management department on verifying eligibility for patients admitted to the hospital and other facilities
- Ideal candidate will have managed care experience with regard to eligibility and benefits verification. Epic experience is a plus.
- A minimum of 3 years experience in processing enrollment is - preferred.
- Work history emphasis within an independent physician association, management services organization or physician hospital organization is preferred.
- Must understand data processing policies and procedures related to entering, updating, and maintaining patient enrollment information, including knowledge of Health Plans (HMO, PPO, POS, Medi-Cal, Medicare).