Health Plan Enrollment Specialist

Description

Summary :

The Commercial Health Plan Enrollment Specialist is responsible for maintenance of eligibility data, resolving all issues or requests regarding eligibility, facilitating enrollment of potential members, and rendering any needed system updates. Will collaborate in analyzing issues that impact and affect the Eligibility Department's processes and procedures and provide feedback and recommendations.

Essential Functions and Responsibilities :

• Audits performance (accuracy and production) of all external organizations delegated to perform eligibility functions; communicates any required data updates to those organizations in a timely fashion.
• Audits all received enrollment forms and enrollment data entered online by brokers, employer human resources departments, and individuals for accuracy and completeness; drafts communiqués with external entities to resolve any questions.
• Processes updates to member eligibility and demographics per information from brokers, employer human resources departments, management, enrollees, other departments, etc., and ensures that requisite documentation is maintained within the document management system.
• Addresses broker, client, and individual questions related to eligibility issues in a timely fashion; monitors departmental e-mail in-boxes, faxes, telephones, and work queues and responds to inquiries and requests accordingly; works to resolve eligibility issues raised by other departments; assists in the enrollment process by documenting and logging enrollment issues.
• Collaborates with management in the preparation of departmental daily and monthly operational and production reports as required.
• Assists management with oversight of eligibility reconciliations and the capture of appropriate documentation supporting any updates to system eligibility records; coordinates the preparation of enrollment files and tracking of enrollment activities.
• Functions as a liaison between department and enrollment vendors.
• Monitors inventory levels of departmental workload and observes departmental policies and workflows to always ensure maximum production.
• Collaborates with management in the development and maintenance of departmental policies and procedures and desktop procedures according to current business needs as well as industry and regulatory requirements; assists management with the preparation of training materials and presentation of in-services as requested.
• Communicates, collaborates, and cooperates with internal and external stakeholders in a respectful and responsible manner to enhance relationships and render exceptional service.
• Adheres to all Compliance / Program Integrity requirements.
• Complies with HIPAA Regulations.
• Performs other duties as assigned.

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Experience :

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ABOUT APEX HEALTH SOLUTIONS

Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex's unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex's experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care.