Health Plan Enrollment Representative

1 week ago

Sacramento, United States APR Consulting Full time
Health Plan Enrollment Representative

  • Location: Sacramento, California
  • Type: Contract
  • Job #77982
APR Consulting, Inc. has been engaged to identify a Health Plan Enrollment Representative

Location: Sacramento, CA 95833 (Hybrid/Remote)
Position: Health Plan Enrollment Representative
Pay Rate: $25.86/hr
Duration: 13 weeks
Expected Shift: Day 5×8-hour (7:30 AM - 4:30 PM)
Note: Must be local for a couple of days of training in the Sacramento area

SUMMARY
Prepares, processes, uploads, and maintains new member or group registration information in the
enrollment database. Responds to member or group eligibility questions, including verifying
enrollment status. reconciling eligibility discrepancies, analyzing transactional data, and submitting retroactive eligibility changes, as needed. Generates various types of member correspondence. Maintains inventory control of member and group transactions.

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

JOB ACCOUNTABILITIES:
HEALTH PLAN SUPPORT
  • Enters, scans, or updates database information for new enrollments and terminations of group, individual, and ancillary health insurance products, including group employer accounts and individual policy profiles.
  • Processes demographic changes to member records, such as name/address/phone/email changes, primary care provider (PCP) changes, etc.
  • Handles enrollment or eligibility inquiries from Member Services, including processing duplicate ID card requests, reprinting correspondence, and reordering new member materials.
  • Reviews all pending enrollments data for accuracy, analyzes any discrepancies, obtains the correct information, and reconciles the records.
  • Identifies performance gaps, recommends and implements approved improvements to enrollment/eligibility processes.
  • Responds to all correspondence.
STAKEHOLDER SUPPORT
  • Communicates with stakeholders (e.g., brokers; customers; vendors) to obtain information and/or clarify concerns based on initial enrollment/eligibility submissions.
  • Contacts relevant stakeholders for missing information or incomplete enrollment package to determine availability of the files or forms.
  • Reviews enrollment/eligibility submissions (e.g., applications; electronic files) to identify unclear, missing, or validate data, investigates enrollment/eligibility issues or discrepancies.
DATA MANAGEMENT
  • Submits and reviews test or new eligibility electronic files to ensure the format and accuracy of the loaded information is correct.
  • Loads information accurately using working knowledge of relevant file layouts (e.g., flexible spending accounts (FSA), spreadsheet solutions, etc.).
  • Uses appropriate computer applications and tools to manage and report enrollment/eligibility information (e.g., Microsoft Access, Excel, structure query language (SQL) server).
  • Enters and updates enrollment/eligibility information in the relevant databases and systems.
COMPLIANCE
  • Adheres to all audit controls, production standards, and regulatory requirements when loading files, resolving eligibility error, or modifying member profiles.
  • Maintains strictest confidence of all patient protected health information (PHI) and protects all PHI from accidental, intentional, or inappropriate disclosure.
  • Performs and/or reviews audits on enrollment/eligibility information to validate data and to identify areas requiring corrections or modifications.
COLLABORATION
  • Partners with internal and/or external stakeholders (e.g., customers; vendors; brokers; internal teams) to correct errors, issues, or concerns with enrollment/eligibility files or data.
  • Works with cross-functional business partners/departments to prep and to ensure open/annual enrollments readiness.
EDUCATION:
  • HS Diploma or General Education Diploma (GED)
TYPICAL EXPERIENCE:
  • 1 year recent relevant experience
SKILLS AND KNOWLEDGE:
  • General knowledge of health care operations and structure, basic requirements in an integrated delivery system, and the use of information system applications in a health insurance or health care environment.
  • Working knowledge of health insurance concepts related to enrollment and eligibility practices.
  • Basic familiarity with and understanding of the California Department of Managed Health Care (DMHC) regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships.
  • Attention to detail with exceptional time management and organization skills with the ability to balance multiple priorities and take appropriate action in challenging situations.
  • Analytical, negotiation and project management skills, including the ability to work with diverse people.
  • Good attention to detail with time management and organizational skills, including the ability to prioritize assignments and work within standardized policies, procedures, and practices to achieve objectives and meet deadlines.
  • Familiarity with relevant file layouts (e.g., Flexible Spending Accounts (FSA), spreadsheet solutions, etc.) for enrollment system uploads.
  • Proficient skills with Microsoft Office Suite (Word, Excel, PowerPoint), including a general understanding of database management and data validation techniques.
  • Work independently as well as be part of the team, while accomplishing multiple tasks under varied and urgent conditions.
  • Identify and evaluate routine or standard problems, then select appropriate solution from established options.
  • Ensure the privacy of each patient's protected health information (PHI).
  • Build collaborative working relationships with patients, prospective clients, peers, physicians, other healthcare providers, and vendors to provide exceptional customer service. diverse individuals and organizations.

PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the
following link

Our client is the one of the largest Healthcare Staffing Provider in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.

This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.

Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Don't miss out on this amazing opportunity If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you

  • Health Plan Enrollment Representative

    1 month ago

    Sacramento, United States IDR Healthcare Full time

    IDR is seeking a Health Plan Enrollment Representative to join one of our top healthcare clientsin Sacramento, California. If you are looking for an opportunity to join a large organization and work within an ever-growing team-oriented culture, please apply today! Position Overview for the Health Plan Enrollment Representative: Data Management and...

  • Health Plan Enrollment Representative

    4 weeks ago

    Sacramento, United States IDR Healthcare Full time

    IDR is seeking a Health Plan Enrollment Representative to join one of our top healthcare clientsin Sacramento, California. If you are looking for an opportunity to join a large organization and work within an ever-growing team-oriented culture, please apply today! Position Overview for the Health Plan Enrollment Representative: Data Management and...

  • Health Plan Enrollment Specialist

    2 weeks ago

    Sacramento, California, United States IDR Healthcare Full time

    Job SummaryIDR Healthcare is seeking a highly skilled Health Plan Enrollment Representative to join our team. As a key member of our organization, you will be responsible for managing health plan enrollment and ensuring accurate and timely updates.Key ResponsibilitiesData Management and Enrollment Processing: Prepare, process, and maintain new member or...

  • Health Plan Enrollment Specialist

    1 week ago

    Sacramento, California, United States APR Consulting Full time

    Job SummaryWe are seeking a skilled Health Plan Enrollment Representative to join our team at APR Consulting, Inc. This is a contract position with a duration of 13 weeks, working 5 days a week, 8 hours a day, with a pay rate of $25.86 per hour.Key ResponsibilitiesPrepare, process, and maintain new member or group registration information in the enrollment...

  • Enrollment Services Representative

    3 months ago

    Sacramento, United States Carrington College Full time

    Who Are We: Carrington College prepares graduates for professional success by offering Baccalaureate and Associate of Science Degrees and Certificates of Completion in business, medical and technical career fields. We help students achieve success by providing them with "hands-on" training that uses the technologies and processes that are used in the field,...

  • Enrollment Services Representative

    3 months ago

    Sacramento, United States Carrington College Full time

    Job DescriptionJob DescriptionWho Are We: Carrington College prepares graduates for professional success by offering Baccalaureate and Associate of Science Degrees and Certificates of Completion in business, medical and technical career fields. We help students achieve success by providing them with "hands-on" training that uses the technologies and...

  • Customer Service

    5 months ago

    Sacramento, United States Hiring Now Full time

    The consumer comes first within the hospitality industry and that is no exception at Solstice, inc. Our Enrollment Specialists help the local markets by offering products and services from our various clientele to increase their brand awareness and community outreach. As a Client Enrollment Representative, you will be a part of creating and delivering...

  • Customer Service

    2 weeks ago

    Sacramento, United States Hiring Now Full time

    The consumer comes first within the hospitality industry and that is no exception at Solstice, inc. Our Enrollment Specialists help the local markets by offering products and services from our various clientele to increase their brand awareness and community outreach. As a Client Enrollment Representative, you will be a part of creating and delivering...

  • Enrollment Services Coordinator

    2 weeks ago

    Sacramento, California, United States Carrington College Full time

    About the RoleCarrington College is seeking a highly motivated and results-driven Enrollment Services Representative to join our team at our Sacramento campus.Job Summary: The Enrollment Services Representative will play a critical role in encouraging prospective students to pursue higher education and providing support and guidance to the admissions team to...

  • Enrollment Services Coordinator

    9 hours ago

    Sacramento, California, United States Carrington College Full time

    About the RoleCarrington College is seeking a highly motivated and results-driven Enrollment Services Representative to join our team at our Sacramento campus.This is an exciting opportunity to make a meaningful impact on the lives of our students and contribute to the success of our institution.Key ResponsibilitiesEncourage prospective students to pursue...

  • Enrollment Support Specialist

    3 weeks ago

    Sacramento, California, United States Carrington College Full time

    About the RoleCarrington College is seeking a highly motivated and results-driven Enrollment Services Representative to join our team at our Sacramento campus.Key ResponsibilitiesEncourage prospective students to leverage higher education as a means to achieve professional success.Provide supervisory support and coaching to the admissions team to ensure...

  • Patient Access Representative

    2 weeks ago

    Sacramento, California, United States Sacramento Native American Health Center Full time

    Job SummaryThe Sacramento Native American Health Center is seeking a highly skilled and compassionate Patient Access Representative to join our team. As a Patient Access Representative, you will play a critical role in ensuring that patients receive timely and accurate information about their insurance eligibility and benefits.Key ResponsibilitiesVerify...

  • Enrollment Specialist

    4 weeks ago

    Sacramento, California, United States Unitek Education Full time

    About UsUnitek Education is a prominent institution in the healthcare education sector, dedicated to assisting numerous students in launching and advancing their careers annually. As a thriving and successful organization, we provide an excellent environment for a fulfilling and challenging career.Position OverviewWe are seeking an Enrollment Specialist to...

  • Enrollment and Eligibility Coordinator

    4 weeks ago

    Sacramento, California, United States APR Consulting Full time

    Enrollment and Eligibility Coordinator Type: Contract Job #77359 APR Consulting, Inc. is seeking a dedicated Enrollment and Eligibility Coordinator.Position Overview: The role involves managing and overseeing the registration processes for new members or groups within the enrollment database. This includes addressing inquiries related to member or group...

  • Enrollment Director

    1 week ago

    Sacramento, California, United States Merryhill School Full time

    Enrollment Director OpportunityMerryhill School, a leading private education provider, is seeking an experienced Enrollment Director to join our team. As a key member of our admissions team, you will play a pivotal role in welcoming new students to our campuses and driving enrollment growth.Key Responsibilities:Develop and execute strategic enrollment plans...

  • Regional Enrollment Advisor

    4 weeks ago

    Sacramento, California, United States Universal Technical Institute Full time

    Overview:The Regional Enrollment Advisor plays a pivotal role in transforming lives by guiding students towards their aspirations through vocational education. This position is ideal for individuals who thrive in a dynamic, target-oriented, and compliance-driven atmosphere. If you are a driven, engaging sales professional with a knack for coaching,...

  • Member Service Representative

    2 weeks ago

    Sacramento, United States Sacramento Native American Health Center Full time

    Here at SNAHC, you are joining a team and company at a time of growth and transformation. You will love being surrounded by people who are as passionate as you are about healthcare and giving back to the community. Please note that individual total compensation for this position will be determined at the Company's sole discretion and the wage range for this...

  • Provider Enrollment Specialist

    4 weeks ago

    Sacramento, United States MedAmerica, Inc. Full time

    Remote, Nationwide Seeking Provider Enrollment Specialist Everybody Has A Role To Play In Transforming Healthcare At Vituity you are part of a larger team that is driven by our purpose to improve lives. We are dedicated to transforming healthcare through our culture by working together to tackle healthcares most pressing challenges from the inside. Join the...

  • Facility Planning Specialist

    1 week ago

    Sacramento, California, United States Sutter Health Full time

    Job SummaryWe are seeking a highly skilled Facility Planning Specialist to join our team at Sutter Health. This role will provide direct support in programming and planning for capital construction projects, coordinating multidisciplinary user meetings, and facilitating clinical process assessment.Key ResponsibilitiesCoordinate with architects to ensure...

  • Facility Planning Specialist

    6 days ago

    Sacramento, California, United States Sutter Health Full time

    Job SummaryWe are seeking a highly skilled Facility Planning Specialist to join our team at Sutter Health. This role will provide direct support in programming and planning for capital construction projects, coordinating multidisciplinary user meetings, and facilitating clinical process assessment.Key ResponsibilitiesCoordinate with architects to ensure...