Enrollment Coordinator

1 week ago

San Jose, California, United States Santa Clara County Health Plan Full time
Job Summary

We are seeking a highly skilled Enrollment Coordinator to join our team at Santa Clara County Health Plan. As an Enrollment Coordinator, you will play a critical role in ensuring the accuracy and timeliness of enrollment and eligibility data for our members.

Key Responsibilities
  • Complete data entry for Medicare paper applications and workflow tasks for all Medicare enrollment and disenrollment requests.
  • Analyze, verify, and resolve beneficiary enrollment, disenrollment, eligibility, demographics, and primary care provider assignment changes and issues.
  • Accurately document and code all contacts and follow-up actions for member, provider, and other communications and activities.
  • Track, analyze, validate, and process assigned daily, weekly, and monthly enrollment and membership eligibility, integrity, audit, reconciliation/validation, and error reports.
  • Identify, investigate, troubleshoot, and report eligibility and enrollment issues, errors, and/or discrepancies.
  • Provide input to required internal and external reporting, including dashboards.
  • Ensure process for delivering member materials to new and existing members is completed accurately and within the required timeframe.
  • Use operating instructions and tools needed to support department activities and to ensure compliance with all regulations.
  • Provide direct support for new member enrollment and for member retention via inbound and/or outbound calling.
  • Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training, and coaching sessions.
Requirements
  • High School Diploma or GED.
  • Minimum one year of experience in jobs requiring interaction with members/patients/clients/customers, with preference for experience working in a healthcare setting.
  • Able to efficiently alternate focus between telephone and non-telephone tasks to support Department operations as dictated by business needs.
  • Prior experience with managed care plans, Medi-Cal, and Medicare programs, and working with underserved populations.
  • Work weekends and company holidays as needed based on business and regulatory requirements.
  • Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills.
  • Working knowledge of and the ability to efficiently operate all applicable computer software, including computer applications, such as Outlook, Word, and Excel.
  • Ability to use a keyboard with moderate speed and a high level of accuracy.
  • Excellent communication skills, including the ability to express oneself clearly and concisely when providing service to SCFHP members and providers over the telephone, in person, or in writing.
  • Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes.
  • Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position.
  • Ability to maintain confidentiality.
  • Ability to comply with all SCFHP policies and procedures.
  • Ability to perform the job safely with respect to others, to property, and to individual safety.
Working Conditions

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

Physical Requirements
  • Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders, and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time.
  • Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds.
  • Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less.
  • Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment.
  • Hearing/Talking Requirements: ability to hear normal speech, hear, and talk to exchange information in person and on telephone.
  • Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail.
Environmental Conditions

General office conditions. May be exposed to moderate noise levels.

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