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Healthcare Enrollment Specialist

2 months ago

Buffalo, New York, United States Centivo Full time

At Centivo, we are dedicated to supporting workers and their employers, who form the backbone of our economy. Our mission is to provide affordable, high-quality healthcare to those who face challenges in managing their healthcare expenses.

We are currently seeking Enrollment & Eligibility Coordinators to become integral members of our team.

As an Enrollment & Eligibility Coordinator, your primary responsibility will be to manage the daily administration of files, data, updates, and transmissions related to medical plan enrollment and member eligibility. You will also assess the qualifications necessary for enrollment in the group's medical plans, which includes verifying coverage rules, coordinating benefits, and validating medical ID cards.

Key Responsibilities:

Under the supervision of the Enrollment Lead, you will:

  • Examine systems for eligibility, reinstatement, and termination of healthcare coverage.
  • Conduct weekly audits for assigned clients using member census data to ensure accuracy in coverage and monitor for file feed issues.
  • Identify the root causes of discrepancies in enrollment data and collaborate with relevant contacts to resolve them.
  • Perform client census reviews for auditing and billing purposes.
  • Facilitate manual enrollment of members into our system when necessary, including gathering and entering demographic information and issuing new member IDs.
  • Oversee and validate ID card releases for all groups.
  • Assist in the loading, transfer, and archiving of daily ID card print files from our claims record system to our print vendor, ensuring proper holds are in place and cards are released according to daily schedules.
  • Monitor and respond to eligibility messages and requests from Member Care/CSM and directly from client contacts through various communication channels.
  • Collaborate with Implementation and Account Management teams on issues related to group enrollment and COBRA.
  • Engage with external carriers/vendors to ensure accurate reflection of member eligibility.
  • Support groups in our employer portal.
  • Manage coordination of benefits for members.
  • Oversee and process claims in the SDS queue.
  • Request and evaluate legal documents such as divorce decrees, marriage certificates, and birth certificates to determine dependent eligibility in accordance with plan rules.
  • Identify potential claims impacts resulting from eligibility updates.
  • Meet standard performance metrics and SLAs established for the Eligibility team.
Qualifications:

Required Skills and Abilities:
  • Ability to prioritize and organize work effectively to meet deadlines.
  • Capability to navigate multiple systems/programs to investigate issues.
  • Intermediate proficiency in Microsoft Excel.
  • Strong customer service orientation.
  • Excellent verbal and written communication skills.
  • Problem-solving and analytical abilities.
  • Attention to detail.
  • Proven ability to manage multiple assignments competently and efficiently.
  • Strong interpersonal skills, fostering rapport and collaboration with others.
  • Knowledge of benefit plans, policies, and procedures, along with an understanding of medical terminology.
Education and Experience:
  • High school diploma or GED required; Associate's or Bachelor's degree preferred.
  • 1-2 years of experience in the healthcare sector is preferred, but not mandatory.
Preferred Qualifications:
  • Experience with automated and integrated claim adjudication systems, such as El Dorado-Javelina and/or Health Rules Payer, is advantageous but not essential.
  • Ability to interpret health plan eligibility rules as outlined in the Summary Plan Description (SPD) document.
  • Knowledge of Coordination of Benefits and Medicare.
  • Experience with the Zelis vendor platform and ID card configuration is a plus.
Work Location:

The ideal candidate will be based in a flexible work environment, with options for remote work available for strong candidates.

Pay Transparency:
The salary range for this position reflects our expectations for the base salary. Additionally, our comprehensive benefits package includes various components that contribute to total compensation, such as bonuses, health benefits, paid time off, and equity options.

Our Values:
  • Resilient: We understand the challenges of healthcare affordability and remain committed to our mission, ensuring we persevere through difficulties.
  • Uncommon: We strive to innovate and improve the healthcare system for members, employers, and providers, building a better solution from the ground up.
  • Positive: We support one another, celebrating achievements and providing constructive feedback, fostering a positive and collaborative work environment.
About Centivo:

Centivo is an innovative health plan designed for self-funded employers, dedicated to delivering affordable, high-quality healthcare. Our primary care-based ACO model allows us to save employers significantly compared to traditional insurance carriers while providing employees with substantial savings through free primary care, predictable copays, and no-deductible benefit plans. We partner with employers of various sizes, from small businesses to Fortune 500 companies.