Enrollment And Eligibility Specialist

Summary

Join Brighton Health Plan Solutions (BHPS) as a remote Enrollment and Eligibility Specialist! This role involves managing member profiles, conducting data analysis, troubleshooting inquiries, and collaborating with various teams. You will work with employers, members, and internal teams to ensure accurate eligibility and resolve issues. The ideal candidate possesses experience in eligibility requirements, data entry, and strong interpersonal skills. This position requires proficiency in various software applications and a deep understanding of healthcare regulations. The role offers a chance to contribute to a company focused on improving healthcare access and delivery.

Requirements

• Ability to work alternate schedules/hours based on the business’s need. Our client is on the West Coast.  As such, the department’s hours are 10am-9pmEST (7am-6pm PST)
• Bachelor’s Degree preferred or High School diploma / GED (or higher) OR 5-7 years of equivalent working experience
• 2+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
• Knowledge of managed care, labor and commercial carrier enrollment and eligibility procedures including hourly based eligibility and waiting periods
• Must be able to process and/or enter sensitive PHI and confidential Financial Information
• General knowledge of HIPAA Confidentiality laws
• Moderate proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications
• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
• Ability to use critical thinking to solve complex problems and identify when to escalate
• Excellent attention to detail, analytical, and good problem solver
• Excellent attendance, punctuality and work performance record required
• Must maintain a high-level of professionalism and communication skills (written and verbal) at all times
• Excellent interpersonal and organizational skills
• Must be susceptible to change and change management
• Must be a team player that is able to work independently as well

Responsibilities

• Create, audit, process and update the member and eligible dependents’ profile(s) into the enrollment database & update the database with changes
• Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes
• Troubleshoot Enrollment and Eligibility related inquiries from the Call Center Representatives and Employers
• Work directly with the Finance team to review, process, and resolve inquiries from the employers and premium related issues: including outreach to employers, the client and State officials --as needed
• Contact Employers regarding delinquencies and late file submissions –when applicable
• Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of requests from the client, employers, and members
• Participate in activities designed to improve customer satisfaction and business performance
• Solve problems that are sometimes out of the ordinary and that may require reliance on conceptual thinking. Maintain broad knowledge of client requirements, procedures and key contacts
• Support projects and other departments in completing tasks/projects

Preferred Qualifications

• Knowledge of eligibility files and transaction sets a plus
• Proficiency in HIPAA, COBRA, FMLA, LOAs, QLE, PTO regulations and other eligibility related transactions preferred
• Knowledge of Medicare/Medicaid Benefits is a plus
• Knowledge of Salesforce is a plus
• Strong interpersonal skills (preferably some Call/Contact Center) experience to resolve member eligibility queries