Enrollment Representative Lead - HP Enrollment Eligibility

Summary:

The Health Plan Enrollment Representative Lead performs duties relative to financial aspects for member care including financial counseling, billing and collection of accounts, assists management with various other duties as necessary. Under the supervision of the Enrollment Manager/Supervisor, this position will provide efficient and timely processing of project request. The associate will prioritize and coordinate task and projects. This position core responsibilities include, pulling eligibility/billing data for regulatory reporting requirements, analyzing eligibility/billing data, working created statistical reports for the Enrollment Representative Team Lead. This position will be responsible for working various workgroup queues, and other duties as assigned. The core responsibilities will be aligned with the timely and accurate entry of all phases of the enrollment/billing process and coordination/communication across departments, internal and external customers, for an exceptional level of service to our members.
This job will be responsible for applying for a Common Access Card (CAC) and will need required approval to be in good-standing by the government for utilizing various databases of information on uniformed services members, U.S. sponsored foreign military, DoD and uniformed civilians, as well as other personnel as directed by the DoD, and their family members. The CAC application process supports the CHRISTUS US Family Health Plan (USFHP) TRICARE Operation Manual (2015 Edition – T17; 2021 Edition – T5) Chapter 14, Section 1 Contracting Requirements.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Provide application assistance and facilitate enrollment of eligible members and community members health insurance programs.
• Maintain knowledge and expertise in eligibility, enrollment and billing; and program specifications for U.S. Family Health Plan, Medicare, Medicaid, and or the Federal marketplace.
• Enrollment activities for members via paper, file transfer, or internet enrollment processing.
• Consistently meet and exceed Service Level Agreements related to enrollment and disenrollment process.
• Maintain detailed tracking of each function within the enrollment and disenrollment process including correspondence and accuracy of member ID cards.
• Maintain detailed tracking of all quality data updates within the enrollment and disenrollment process.
• Communicates verbally and in writing with members, third parties and other departments as required to facilitate the enrollment, disenrollment and billing processes.
• Responds to internal and external customer inquiries regarding eligibility and related functions.
• Enters information during the enrollment process that assists claims personnel in claim adjudication including COB.
• Performs reconciliation of system data vs program data.
• Receives and works with incoming eligibility from a variety of sources.
• Consistently meets or exceed department and company standards and expectations including but not limited to quality, productivity and attendance.
• Maintain confidentiality for all customers.
• Receives, processes and respond to correspondence or phone inquiries from members.
• Compile data, tracks results and reports to management.
• Attend meeting when applicable.
• Perform other duties as assigned.
• Responsible for initial and/or renewal application for Common Access Card (CAC) to support the CHRISTUS USFHP product line of business. Must complete various government documentation and Cyber Security Training for complete approval from the TASS office by entering information that is correct to the best of the applicant’s knowledge.
• Communicates verbally and in writing with the Facility Security Officer (FSO) during the entirety of the CAC process and completion. This includes undergoing an extensive background check with the government, completing fingerprinting, and requesting permission from the DHA Contracting Officer (KO).

Requirements:

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time