What are the responsibilities and job description for the Eligibility Coordinator position at ProCare Rx?
PRINCIPLE RESPONSIBILITIES include but are not limited to:
- Coordinates the input of member eligibility for all new groups
- Assists with the implementation process for new clients
- Coordinates with client contacts to ensure information is received is accurate and timely
- Enrolls on-line management (Portal) users and maintains accounts
- Enrolls new members and/or processes terminations
- Works with multiple departments to coordinate eligibility requirements
- Utilizes both manual and systematic enrollment process
- Reviews daily reporting for eligibility corrections
- Answers incoming telephone calls related to eligibility needs
- Ensures eligibility systems are updated and data is appropriately integrated on a daily basis
- Maintains the eligibility files for medical coverage recipients (PHI)
- Handles escalated eligibility issues to ensure problems are resolved
- Ensures that all correspondence and eligibility files are properly maintained
- Perform scheduled review and quality assurance for member eligibility
- Assist with go-lives and testing data files
- Performs various related duties as assigned including but not limited member communications, personal importation, overflow IC phone support, pharmacy network tasks; etc.
SKILLS AND REQUIREMENTS:
- High school diploma or equivalent required.
- Post high school or specialized training in medical field desired.
- Minimum three years experience in a customer service position, preferably as an Office Manager or a similar service position in the health care industry.
- Must have excellent communication skills and the ability to work effectively with clients, pharmacies, and plan members, internal and external contacts.
- Proficient PC skills in Windows-based applications.
- Health insurance background and knowledge of pharmacy terminology desired.
- Ability to be flexible and quickly adapt to changing needs in department.
- Must be highly organized with strong attention to detail.
- Must be flexible with scheduled work hours.
PHYSICAL DEMANDS
Requires sitting, standing, and occasional light lifting