Job Summary:

The Enrollment Specialist II is responsible for reviewing files and interpreting data to enter members into eligibility systems according to appropriate regulatory guidelines.

Essential Functions:

• Process work items according to appropriate regulatory guidelines
• Review files and interpret the data to enter members into eligibility systems
• Completion of daily change file pre-processor exceptions and monthly full file pre-processor exceptions
• Research member eligibility and take appropriate actions to resolve issues across all eligibility systems
• Process mass Primary Care Physician (PCP) changes with Provider Operations
• Research, review,  and interpret eligibility data to respond to eligibility inquiries from contracted vendors
• Access state and federal government systems to review and confirm eligibility status
• Process paper applications received for all applicable lines of business
• Inbound phone coverage to answer inquiries from both internal and external customers
• Complete all required corporate training within stated timelines to a satisfactory manner
• Perform any other job duties as requested

Education and Experience:

• High School Diploma or equivalent required
• Associate’s degree in accounting, finance or business related field or equivalent work experience is preferred
• Minimum of two (2) years of healthcare, insurance, or related industry experience to include at least one (1) year of enrollment/eligibility or similar experience is required

Competencies, Knowledge and Skills:

• Familiarity with Microsoft Word and Excel
• Excellent verbal and written communication skills
• Ability to work independently and within a team environment
• Attention to detail
• Familiarity of the healthcare field
• Knowledge of Medicaid and Medicare preferred
• Critical listening and thinking skills
• Proper grammar usage
• Time management skills
• Proper phone etiquette
• Customer service oriented
• Decision making/problem solving

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$40,400.00 - $64,700.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Hourly

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

#LI-SD1