At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.
How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community.
Now hiring Enrollment Specialist
Summary:
The Enrollment Specialist is responsible for maintaining current and accurate membership records by administering contractually defined eligibility and enrollment period guidelines and processing group and member transactions. In addition, Enrollment specialists must be member focused in responding to questions or issues from health plan members and stakeholders regarding insurance benefits and coverage. Responsible for gaining a working knowledge of all federal and state regulatory requirements relative to enrollment and eligibility. Responsible for achieving prescribed department performance standards on a consistent basis.
Ideal Candidate: Ideal Candidate/Prefer Qualifications/or Why this position is unique
Location and Commitments: Albuquerque, NM
Full Time - Exempt: No
Job is based Rev Hugh Cooper Admin Center
Work hours: Weekday Schedule Monday-Friday
Overtime:
Weekends:
Travel:
High school diploma plus one to three years office/business experience; call center experience preferred and/or is currently demonstrating customer service skills, meeting current department metric and attendance guidelines within department. Claims processing experience in managed care with possible enrollment experience is preferred. Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff. Written communication skills as well as business writing and presentation skills are required. Requires strong organizational skills, ability to create, sort and analyze reports (Excel, Access, etc) and system processes. Must be able to type accurately and demonstrate proficiencies in typing skills, 40 wpm with 95% accuracy. Must be able to work closely with other team members and function efficiently under pressure. Must successfully complete Enrollment/Eligibility Specialist competency evaluations. Ability to process information with high levels of accuracy and identify trends.
As an Enrollment Specialist you'll be responsible for entering and maintaining eligibility information for members and groups including:
*Processing enrollment eligibility, demographic changes, ID card request for various product lines
*Understanding and administering eligibility/enrollment guidelines including waiting periods, continuation guidelines, maximum age policies, including the student certification process for specified groups.
*Generating all required member enrollment materials
*Coordinating the processing of member identification cards
*Reporting status of Service Level Agreements to Enrollment Leadership
*Performing at prescribed accuracy and turn around performance goals, 98% Accuracy
*Troubleshooting and resolving member eligibility inquiries real time
Assists in the development of documentation of process and procedures into functional process improvements to enhance overall level of service to our customers and partners. Uses the Improvement model, identifies patterns in urgent member issues, conducts root cause analysis and reports to management team
We're all about well-being, starting with yours. About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1200 providers and nearly 3,500 nurses.
Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments .
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. Compensation decisions are dependent upon the facts and circumstances of each offer.
USD $21.01/Hr.
