Enrollment Specialist

Location: Monterey Park, CA
Date Posted: 09-10-2018
CareNational
Enrollment Specialist – Managed Care
Monterey Park, CA (Eastern Suburb of LA)
 
**Full-Time, Benefits Available CONTRACT opportunity, expected to last around 6 months, or longer! **
 
Enrollment Specialist Job Summary:
  • Responsible for the processing of enrollment and disenrollment of members, maintenance of the eligibility information, and systematic transmission of authorization and referral files to and from the appropriate vendors.
  • Receives and processes member enrollment and disenrollment cards.
  • Acts as primary liaison for any enrollment/disenrollment questions from state, staff, and vendors.
  • Develops and updates policies and procedures related to enrollment/disenrollment processing.
  • Downloads and processes eligibility files from the State in a timely manner to assure timeliness of referral/authorization and claims processing for members.
  • Maintains eligibility tables/data files and assure accuracy in enrollment reports as identified in enrollment processes
  • Assists in resolution of any provider/enrollee complaints/appeals that relate to eligibility problems.
  • Detailed understanding of Medicaid eligibility terms and processes (card print, cutoff, CARES/MMIS interface, Social Security eligibility interface.)
  • Responsible for systematic transmission of referral/authorization files to and from the appropriate vendors.
Enrollment Specialist Background: 
  • Requires an education level of at least a high school diploma or GED; Associate’s or Bachelor’s degree is a plus.
  • Requires exceptional phone / customer service skills, as well as very strong computer user skills.
  • At least 1 year experience in a hospital or health plan call center, including Medi-Cal and Medicare support experience.
  • Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
  • Knowledge of health care delivery system, Medicaid/Medicare and related state programs is preferred.
  • Advanced computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
  • Must have a minimum of 35 wpm typing with a high level of accuracy.

  #ADMIN
 
DAVID DIVITO
DIVISION DIRECTOR
CareNational
david@carenational.com
480.425.2451 (CALL – TEXT – FAX)
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