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Enrollment Specialist

1 month ago

Sacramento, United States Tech One IT Full time

Role: Enrollment Specialist

Job Location:Sacramento, CA 95833 (Remote)

Client: Sutter Health

Rate: $25/hr on W2

Required Skills:

Enrollment,TIME MANAGEMENT, compliance, Health Care, Regulatory

Description:

Hybrid: Remote/ Must be local for a couple of days(2-3 days in a month) for training in the Sacramento area

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.

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

Description

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.