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Enrollment Representative
RENO NV 89505
Category: Health Care Industry
  • Your pay will be discussed at your interview

Job code: lhw-e0-88399014

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Renown Health

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Summary

  Job posted:   Tue Apr 17, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
Enrollment Representative
Enrollment Representative

Requisition id: 138538


Department: 520604 Premium Billing


Facility: Hometown Health


Schedule: Full Time - Eligible for Benefits


Shift: Day


Category: Clerical & Administrative Support


Location: Reno, NV


Position Purpose: This position is responsible for performing activities and functions related to enrollment of new business, audit new and renewal business and ensure that groups and members are enrolling based on eligibility requirements for Hometown Health's commercial insurance, self funded and Medicare product lines. In addition, is responsible for the eligibility verification of all enrollment transactions, completes auditing tasks and system improvement processes. Nature and Scope: Under the direction of department leadership and the Director of Finance, the Enrollment Representative will verify eligibility and complete all enrollment transactions for Medicare, Individual and Family plans, Small and Large Group clients and the enrollment administrative requirements for its third-party administrator business including but not limited to large group TPA and the Independence Plan clients.


The position responsibilities include: * Strict adherence to all Federal and State regulations and our State of Nevada department of insurance guidelines. * Strict adherence to eligibility and enrollment criteria governed by the Centers for Medicare & Medicaid Services (CMS) Medicare Managed Care Manual. * Ensuring all enrollment forms are audited to comply with the group's eligibility provision, the commercial evidence of coverage, the group subscription agreement and the summary plan documents for self funded clients. * Entering enrollment transactions timely and accurately per the enrollment procedures. * Ensuring reconciliation of all enrollment transactions to the enrollment forms to verify appropriate family coverage and tier match Hometown Health system. * Working closely with our group administrators/contacts and members to ensure that enrollment is processed timely and accurately to avoid delay of enrollment, termination or disruption of their benefit plan when information received is not complete. * . * Managing workloads independently as well as part of a team. Ability to work on multiple and complex tasks with high quality results and adherence to deadlines. Maintain regular communication with Leadership, Enrollment Specialist, Configuration Analyst and customers. Following procedural lists to develop, compile and process all enrollment information received to maintain accurate membership information for billing, claims payment, ID card and Provider/Member benefit plan utilization. Verifying eligibility in multiple databases, including but not limited to Medicare Advantage Prescription Drug (MARx) system, the Group Eligibility Provision, Evidence of Coverage Document, Group Subscription Agreement, Group Self Funded Summary Plan Document, Departmental policies & procedures, Provider Directory before coding and entering membership into the Hometown Health's managed care information system. Performing critical thinking and analysis in determining the appropriate group, benefit package and riders to assign to members. * Provides system expertise and training to other Representatives. * Periodically assists Enrollment Specialist with quality auditing tasks. Providing detailed, accurate and timely membership data entry. Composing and editing correspondence to internal and external customers. Maintaining records and files in electronic systems. Compiling audit-related and miscellaneous documents regarding enrollment. Responsible for collecting legal documents from members to verify eligibility. Working closely with group administrators and members to collect information requested. * Performing other revenue-related duties as assigned. * Works closely with Marketing Sales Team to accomplish membership goals by managing timely entry of membership.


This position does not provide patient care .


Incumbent should possess the skills to type a minimum of 30-40 WPM adjusted for error. Must have strong computer skills including expert level understanding of Microsoft Office Suite, including Outlook, entry level skills in working with Excel spreadsheets and formulas in addition to possessing basic Word skills.


The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications: Requirements - Required and/or Preferred Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Computer literacy, intermediate word processing/excel spreadsheet skills and 40 wpm typing ability essential. Experience: Three years of office experience required. Experience in an insurance, clerical or managed care industry preferred. License(s): None Certification(s): None Computer / Typing: Must have within 90 days the ability to use the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.


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