Data Entry: Membership Processing
Innovative Healthcare Company based in Portland, OR looking for a Membership Eligibility Processor for a 3-month contract!
The primary responsibility of this position is to communicate with groups and brokers to obtain missing or conflicting information on enrollment applications. Other duties may involve establishing and maintaining accurate subscriber and member level eligibility through processing of new applications, member additions and deletions, policy revisions, demographic changes, renewal changes and any other maintenance affecting eligibility.
Minimum Job Qualifications and Technical Competencies
* High school diploma or GED
* 30 wpm keying
* 10-key by touch
* Six months data entry experience with demonstrated ability to meet or exceed accuracy and production standards.
* Must be detail-oriented and self-motivated
* Must be dependable and maintain attendance at or above departmental standards
* Must be able to exercise judgment, initiative and discretion in confidential, mature and sensitive manner
* Must be able to establish effective working relationships with staff and customers
* Ability to understand mathematical calculations and concepts
* Ability to organize and prioritize work
* PC experience required; experience with Word, Excel and Lotus notes or similar software
* Ability to communicate effectively both verbally and in writing
* Medical Terminology preferred for WSHIP health questionnaire processors
* The primary responsibility of this position is to communicate with groups and brokers to obtain missing or conflicting information on enrollment applications.
* Place calls to obtain information required to complete application processing such as calling an employer, member or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan.
* Process individual, small, large, trust or specialized group enrollment applications. Calculate appropriate waiting period credit, eligibility data, effective date and enter benefits, bank draft identification information, name, social security number, address, family members and primary care physician information with network coding, which is consistent with contract.
* Review, maintain and enter changes on individual and/or group & trust accounts which may include change of effective date(s) for subscriber coverage or subscriber dependents, addition or deletion of insured or dependents from coverage, etc.
* Perform all eligibility tasks accurately and timely to meet MTM requirements.
* Generate group or individual billings.
* Order member cards
* Identify and prioritize work in order to meet deadlines including state requirements for timeliness.
* Incorporate and apply changes made to Membership Accounting, Underwriting and State and Federal policies and procedures to ensure current requirements are met.
* Responsible for meeting established departmental performance expectations.
* Ensure member confidentiality in all aspects of eligibility and billing processes.
* Comply with MTM standards as well as Consortium standards as they relate to group membership activities.
* Handle responses to inquiries to meet standards and corporate goals.
* Conduct business in compliance with the Corporate Code of Business Conduct. Immediately report violations of the code to management, human resources, internal audit, legal or the compliance officer; and aid in investigating alleged wrongdoing.
* Maintains high regard for member and Medicare beneficiary privacy and complies with The Regence Group’s Corporate Privacy and information security policies.
* Responsible for quality and continuous improvement within the job scope.
* Responsible for all actions/responsibilities as described in company-controlled documentation for this position.
* Contributes to and supports the corporation’s quality initiatives by encouraging team and individual contributions toward the corporation’s quality improvement efforts.
* Provide customer service to internal customers and may place and track outgoing calls to external customers including groups, agents and subscribers to obtain information necessary for enrollment.
* Ability to review and apply eligibility rules for trust employees.
OTHER JOB DUTIES AND RESPONSIBILITIES
* Willing to work overtime as necessary.
* Perform various clerical tasks.
* Attend and participate in training, staff meetings and team briefings.
No unusual working conditions.
Work is primarily performed in an office environment.