SCAN Temp Employee
1 month ago
SCAN Temp- Eligibility Coordinator
Full-Time
About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit , , or follow us on LinkedIn, Facebook, and Twitter.
The job
To maintain SCAN Health Plan's core eligibility system by reconciling, entering, correcting, and deleting member information.
You will
Processes member applications by reviewing data for deficiencies; assigning codes to data; establishing data entry priorities and resolving discrepancies by using departmental policies and procedures. Enter member data by inputting alphabetic and numeric information into IKA system according to screen format including benefit assignment, group affiliation, and provider selection, billing information, revenue codes and appropriate cross references. Verify eligibility for enrollment using state and Federal websites. Provide excellent customer service by making a high volume of outbound calls to members to clarify, obtain, and or confirm information needed to successfully complete member’s enrollment request. The ability to accurately interpret and explain eligibility and CMS regulations and requirements in person, via email or telephonically Complete requests received through Enterprise, Department Inbox, and Department Queue by responding appropriately and in a timely fashion to internal and external customers; by answering telephonic and written inquiries concerning eligibility issues; following department policies and procedures; by professionally representing the department to others. Prepare eligibility report mailings by generating, reviewing and distributing eligibility information to providers within defined timelines. Prepare member correspondence by creating, triggering, printing, reviewing and mailing. Assure accurate data from regulatory system reply by utilizing Federal systems and other departmental systems to run reports and collect and analyze data for any necessary updates. Responsible for daily reconciliations, to resolve member eligibility Issues by analyzing, correcting or updating data received on daily claims error report, unassigned PCP list and Incomplete Queue. Reconcile discrepancies between member data and various systems. Research eligibility rejected transactions by identifying discrepancies and reporting findings to the appropriate business area. Ensure regulatory compliance by following departmental desktops, policies and procedures, by adhering to state and Federal regulations and requirements. Assist co-workers by training, updating processes, and assisting with job duties. Represent the department by attending meetings, trainings, and process improvement teams. Maintain professional and technical knowledge by utilizing access to SCAN University on-line trainings, attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Contribute to team effort by accomplishing related results as needed. Actively support the achievement of SCAN’s Vision and Goals. Other duties as assigned.Your qualifications
1 year experience in Medicare managed care health plan required. Experience in a managed care environment is preferred. Ability to provide professional customer service. Ability to work well in a fast-paced and dynamic environment. Strong interpersonal skills, including excellent written and verbal communication skills. Strong organizational skills; Ability to multitask. Ability to appropriately maintain confidentiality. Strong analytical and critical thinking skills, required.What’s in it for you?
Base Salary range: $$ Robust Wellness Program Excellent 401(k) Retirement Saving Plan with employer match. Robust employee recognition program A work-life balanceAn opportunity to become part of a team that makes a difference to our members and our community every day
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