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Eligibility Analyst - Member Enrollment Billing, HFHP, Full-Time
MELBOURNE FL 32941
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-85649832

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Summary

  Job posted:   Sat Mar 10, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
Eligibility Analyst - Member Enrollment Billing, HFHP, Full-Time
The HFHP Eligibility Analyst is responsible and accountable for providing Quality / No Harm, Customer Experience, and Stewardship by analyzing all enrollment requests to make appropriate coverage determinations related to eligibility for all lines of business. Success in this position will be based on the individualsââ,¬â,,¢ ability to effectively prioritize work, identify and resolve complex eligibility concerns in a professional manner, and work in a team environment to achieve common goals.
Primary Accountabilities
* Ensures compliance with all CMS enrollment guidance published annually.
* Advanced knowledge of state and federal regulations related to Commercial contracts and Medicare eligibility.
* Advanced knowledge of TPA client Summary Plan Description requirements that may vary from fully-funded Commercial line of business.
* Researches eligibility discrepancies and compiles and submits necessary supporting documentation to Integriguard for correction to CMS.
* Oversees and processes weekly and monthly reports from CMS related to eligibility reconciliation.
* Provides outstanding customer service to both internal and external customers by researching and explaining the status of complicated eligibility requests.
* Compiles daily batches for both lines of business to submit to the BPO.
* Performs quality check of all batches and eligibility requests processed by the BPO to ensure department standards are met.
* Responds to customer inquiries by researching, understanding and documenting plan information related to: Covered benefits and exclusions, Eligibility, Enrollment and disenrollment, Participating providers, Premium billing, and Plan guidelines.
* Works with Eligibility Coordinator to problem solve, develop skills and new processes that improve overall productivity. Identifies opportunities for quality/process improvements as system and/or contract terms change.


* High school diploma with 6 to 12 months of vocation/post high school education or equivalent work experience. College course or degree preferred.
* America's Health Insurance Plans (AHIP) Medicare accreditation preferred.
* Minimum of 5 years health insurance experience and 1 year of Medicare Managed Care experience.
* Advanced knowledge of State and Federal regulations and contracts for HMO plans, POS plans and Medicare.
* Proficient in Microsoft Office including: Microsoft Word; Excel and Access.
* Excellent Customer Service skills with ability to explain complicated benefit issues to members and diffuse hostile encounters.
* Excellent oral and written communication skills.


**Job:** **Operations*

**Organization:** **HF Administrative Plan Inc*


**Title:** *Eligibility Analyst - Member Enrollment Billing, HFHP, Full-Time, 00028296*

**Location:** *Florida - Brevard County-Melbourne*

**Requisition ID:** *034780*

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