Bilingual CCPU Eligibility Specialist II

2 weeks ago

Irvine, California, United States Western Growers Family of Companies Full time
About the Role

We are seeking a highly skilled Bilingual CCPU Eligibility Specialist II to join our team at Western Growers Family of Companies. As a key member of our operations team, you will play a critical role in ensuring the smooth processing of eligibility and billing transactions for our Child Care Providers United accounts.

Key Responsibilities
  • Maintain eligibility and benefit applications for CCPU accounts, including providers that submit eligibility electronically.
  • Review and process manual and EDI enrollment transactions, ensuring compliance with Participation Agreements, Employer Policies, Eligibility Guidelines, and Summary Plan Descriptions.
  • Produce electronic spreadsheets and reports for audit and processing purposes.
  • Research and correct benefit application issues, determine and correct out-of-balance items on accounts, and contact clients to explain and resolve billing reimbursement discrepancies.
  • Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure the protection of confidential client and enrollee data.
Requirements
  • High school diploma or equivalent, or three to five years of accounting/business experience with knowledge of generally accepted accounting procedures, analytical abilities, or equivalent combination of education and experience.
  • Excellent oral and written communication skills in English and Spanish, including modern business communications, formatting of professional letters, reports, and phone etiquette.
  • Comprehensive command of the Spanish language, with the ability to utilize it up to 50% of the time.
  • Knowledge of generally accepted healthcare eligibility and billing procedures, as well as Health Insurance Portability and Accountability Act (HIPAA) and Employee Retirement Income Security Act (ERISA) legislation.
  • Intermediate computer experience with Microsoft Office suite.
  • Strong ability to develop proficiency working with a proprietary healthcare system.
  • Knowledge of processing Electronic Data Interchange (EDI) file updates in a legacy system.
  • Experience providing customer service to a variety of client contacts via email and telephone.
  • Demonstrated ability to research and resolve technical issues and/or client problems with minimal direction.
  • Demonstrated time management skills, including multi-tasking, working under pressure and deadlines, and working independently with minimal supervision or in a team environment.
  • Strong knowledge of health insurance operations and industry.
What We Offer

We offer a competitive compensation package, including a rich benefits package with profit-sharing, as well as opportunities for professional growth and development. Our team is committed to providing a positive and supportive work environment, and we are looking for someone who shares our values and is passionate about delivering exceptional results.

Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the job. We are an equal opportunities employer and welcome applications from diverse candidates. The successful candidate will be required to undergo a background check and provide proof of eligibility to work in the United States.

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