Role and Responsibilities:

• Provides oversight of the Eligibility and Enrollment function within the Access to Care Department
• Assists with creating applicable work reports
• Prioritizes and assigns work to ensure efficient use of resources
• Reviews system reports to ensure compliance with Eligibility and Enrollment policies and procedures
• Notifies appropriate UM staff regarding changes in third party coverage
• Monitors data entry related to member enrollment including; proof of income, proof of residency, proof of medical insurance availability, and identification documents
• Provides functional guidance to the Access to Care Processing Assistants
• Updates account activity and uncovered third party information in the MOC member management system immediately and accurately
• Performs account follow up for positive outcomes by communicating verbally and in writing with both internal and external agencies, such as Access to Care, Utilization Management the Social Security Administration, Social Service Departments, clinical homes, etc.
• Resolves all incoming correspondence pertaining to follow-up on eligibility determination and documentation needed to verify eligibility
• Analyzes accounts to determine appropriate action to be taken for resolution.
• Manages incoming phone calls from both internal and external entities such as members, the LME, other internal and external agency staff to resolve enrollment issues
• Conducts all work in a professional and compassionate manner providing excellent Access to Care to all contacts
• Provides supervision for the Processing Assistants and completes performance appraisals.
• Performs other related duties as assigned