What are the responsibilities and job description for the Eligibility Associate Representative position at Integrated Resources, Inc ( IRI )?
Start Date: 10/14/2024
Quick notes/highlights:
100% work at home
8:30am – 5:00pm EST (prefers candidates who live in EST & CST)
Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle reconciliation for non-standard requests. May provide technical support for the electronic procession of eligibility. Ensures customer data is installed accurately and timely. Technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision, but have ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues.
ESSENTIAL FUNCTIONS
Top 3 Skills:
Analytical skills
Customer Service Skills
Quick Learner
Other Skills
- All candidates will need to be cleared and ready to start on this date
- We understand this is a tight timeline. The manager says she will be hopeful that we can get candidates onboarded and ready this quickly.
Quick notes/highlights:
- Familiarity of/ having a basic knowledge of Medicare will be helpful for these candidates.
- Customer service experience that has exposure to insurance or Medicare will be helpful.
- They will be trained in a few parts of the team and deployed as needed to support different branches of the team
- Need to have basic computer skills. These candidates need to know how to navigate different screens and programs.
- Need to have basic Microsoft Office/Excel skills and experience
- High volume work. When they log-in, they will be assigned a queue of what they need to work on
- They will receive Q-Net and Medicare training, will learn how to process the records they receive in their queues
- Some candidates might have to be on the phone more than others depending on the team they are placed on.
100% work at home
8:30am – 5:00pm EST (prefers candidates who live in EST & CST)
Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle reconciliation for non-standard requests. May provide technical support for the electronic procession of eligibility. Ensures customer data is installed accurately and timely. Technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision, but have ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues.
ESSENTIAL FUNCTIONS
- Facilitates accurate processing of Enrollment applications to ensure timely input and acceptance to CMS.
- Performs account benefit verification requiring complex decision skills based on payer and process knowledge resulting in proper access to care.
- Process Reconciliation files from CMS to include Disenrollments, Late Enrollment Penalties and Low Income Subsidies
- Timely and Accurate processing of monthly Premium payments including identification and processing of write offs, resolution of credit balances and posting of payments to member accounts
- Process Coordination of Benefits and Medicare Secondary Payer files from CMS to meet Federal and State Regulatory guidelines.
- Ensure accuracy of data entry to allow for meeting proper Service Level Agreements
- Use discretion & independent judgement in handling more complex cases and be willing to learn new skills within the Enrollment Functions
- Directly interfaces with other teams within Client
- Provide support to other internal functions as needed.
- May need to be proficient in Multiple Systems
- Completes other projects and additional duties as assigned.
Top 3 Skills:
Analytical skills
Customer Service Skills
Quick Learner
Other Skills
- Knowledge of CMS Enrollment & Reconciliation process
- Knowledge of CMS Billing requirments and regulations
- Knowledge in Coordination of Benefits and Medicare Secondary Payer
- Medicare Part C and Part D
- Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
- Intermediate data entry skills and working knowledge of Microsoft Office.
- Excellent presentation and communication skills.
- Demonstrated ability to handle challenging interactions in a professional manner.
- Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
- Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
- SQL (a plus not required)
- High school diploma or GED required, bachelor’s degree preferred.
- 3 years of relevant working experience.
