Insurance Eligibility Specialist

2 days ago


Scottsdale, Arizona, United States Community Medical Services Full time
Overview

Community Medical Services is seeking a skilled Enrollment Specialist to join our team. This role will be responsible for verifying client eligibility on various Medicaid, Medicare, and Commercial Provider Portals. The successful candidate will maintain day-to-day enrollment and demographic processing in our Electronic Health Record (EHR) and Electronic Medical Record (EMR) systems for all lines of business.

Responsibilities
  • Verify client eligibility on various Medicaid, Medicare, and Commercial Provider Portals
  • Respond to inquiries submitted to our Departmental Inbox (Microsoft Outlook)
  • Maintain day-to-day enrollment and demographic processing in our EHR and EMR systems
  • Identify opportunities to improve process efficiency and accuracy
  • Perform audits and analyses on completed member data in core systems
  • Create, update, and submit demographics to applicable payers
  • Research rejected claims related to member data and resolve discrepancies
  • Provide necessary follow-up to resolve errors, including communication with Operations and Clinical staff
Qualifications
  • High school diploma or equivalent
  • 3+ years of transaction processing, data reconciliation, membership records, or related managed care/healthcare experience
  • Experience in a managed care environment with provider information systems preferred
  • Ability to review at least 1000k client records a month to validate insurance or client balances
  • Ability to review client information in multiple states with different business rules


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