Job Details
Job Location
Corporate Headquarters - Chula Vista, CA
Position Type
Full Time
Education Level
4 Year Degree
Salary Range
$22.31 - $25.66 Hourly
Description
POSITION SUMMARY
Works closely with Enrollment and Information Systems Departments to maintain enrollment data integrity and comply with applicable data availability timelines. Coordinates printing and distribution of member material and correspondence. Works independently and collaboratively to meet enrollment goals, with focused efforts on exemplary customer service, use of technology and systems, teamwork, accuracy and efficiency.
COMPLIANCE WITH REGULATIONS
Works closely with all departments necessary to ensure that processes, programs and services are accomplished in a timely and efficient manner and in accordance with CHG policies as well as State and Federal, regulations including Department of Health Care Services (DHCS) and Centers for Medicare and Medicaid Services (CMS).
RESPONSIBILITIES

• Update enrollment records by analyzing data provided by DHCS and CMS and determining necessary action (e.g. add, term, reinstate, or change).
• Perform enrollment audits to identify and address data discrepancies from the following sources: DHCS enrollment, Other Coverage, CMS enrollment, Marketing applications, MedImpact, and Vision Services Plan.
• Process and mail applicable enrollment and disenrollment correspondence to Medi-Cal, D-SNP and C-SNP members.
• Process block transfer requests received from Provider Relations and ensure adherence to applicable requirements, such as provide a letter of explanation and new ID card when necessary.
• Ensures accurate and efficient processing and evaluation of applications, maintenance and updating member records, timely and accurate communication, data integrity using various methods and systems.
• Support the enrollment month end processes, including review of QNXT Trouble Shooter reports, new member activities (primary care physician assignment, member mailing, mailing house reports, etc.).
• Communicates effectively and accurately via email, telephone, and in person with all customers, including, providers, members and peers.
• Demonstrates sensitivity in working with personal and confidential records and information, adhering to HIPPA and other related practices and policies.
• Assist with creation and modification of departmental policies and desktop procedures.
• Maintain product and company reputation and contribute to team effort by conveying a professional image and accomplishing related tasks; participating in committees and in meetings; performing other duties as assigned or requested.

• Process the new and/or replacement Medi-Cal ID card reports and review for accuracy. Once approved, print and provide cards to Executive Department staff on a daily basis.
• Process the new and/or replacement D-SNP and C-SNP ID card reports and review for accuracy. Once approved send to the mailing house on a daily basis.
• Follow Best Available Evidence process when CMS members provide new benefit information.
• Research, take appropriate action and provide reports to Customer Service in response to files concerning deeming eligibility from CMS.
• Process and monitor D-SNP and C-SNP deemed process. This process involves analyze these members enrollment for three months to follow the regulations to determine if disenrollment is necessary.
• Work with Manager to establish new workflow processes and to change or update existing processes as business requires.
• Research any possible Coverage of Benefits (COB) for members and update enrollment files as necessary.
• Assist with the translation of all member material and correspondence to other languages. This includes other alternate formats such as Braille, audio and large print.
• Work very closely with the Compliance Department to ensure that all member materials comply with State and Federal regulations.
• Process and provide, on a monthly basis, the Marketing Payroll Report for payment of commission.
• On a daily basis, update enrollment records based on information received via claims.
• Process SOGI forms received on a daily basis and maintains track of inventory. Provide support during testing phases for systems upgrades, including QNXT, CHGnxt, EDI reporting, etc.
• Provide support during audits that pertain to Enrollment, such as CMS, DMHC, DHCS and NCQA.
• Maintain excellent communication with providers who have special requests for enrollment.
• Assumes additional responsibilities and performs other related duties and/or projects as needed or assigned.
• Serves as a resource for internal team members and responds to requests and inquiries related to member enrollment.

Qualifications
EDUCATION:

• Bachelor's Degree preferred.

EXPERIENCE/ SKILLS

• Minimum of five years of experience in the health care industry, preferably in Enrollment related activities.
• Knowledge of Medicare Managed Care Enrollment and Disenrollment Manual, Chapter 2.
• Knowledge of CFR 422 and all other applicable codes and regulations.
• Strong customer service background.
• Strong experience and familiarity with data from multiple enrollment sources.
• Experience with and sensitivity to cultural background and linguistic needs of membership.
• Excellent communication and interpersonal skills.
• Ability to exercise mature and independent judgment.
• Strong knowledge of Excel.

PHYSICAL REQUIREMENTS

• Required to work evenings and weekends.
• Prolonged periods of sitting.
• Extensive use of telephone.

Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.