The Associate Enrollment and Eligibility will be responsible for day to day facilitation of member eligibility, enrollment and benefit plan assignment.
Duties and Responsibilities:
- Verifies member eligibility and benefits via health plan websites and/or other methods as appropriate.
- Completes benefit plan builds for all HMO Managed Care plans by completing specification imports with all appropriate benefits (copays, coinsurance, deductibles and MOOP).
- Responsible for contacting health plans for benefit interpretations and to acquire clarification for use in design.
- Works closely with EIS Personnel on EIS-related projects.
- Nurtures two-way communication within department and with end-users.
- Uses Customer Relationship Management tool to connect with internal departments to resolve issues and tasks pertaining to enrollment, eligibility and benefits and adhere to task turn-around times.
- Works eligibility work-queues for any eligibility and benefits issues.
- Determines coverage filing order using NAIC and CMS guidelines for Coordination of benefits.
- Works enrollment audit reports and other system reports to make appropriate eligibility and benefit updates.
- Performs root cause analysis to determine issues related to eligibility and benefits or system errors.
- Identifies issue trends and opportunities for improvement.
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Education:
High school diploma/GED required. Associates degree/college diploma preferred.
Experience:
Two (2) years working with eligibility and benefits in a Managed Care setting Knowledge of CPT, HCPCS, and ICD-10 codes. Experience with EPIC or other similar patient information system(s).
Working Title: Associate Enrollment & Eligibility Specialist - Managed Care
Department: MNS - Managed Care
Business Entity: Cedars-Sinai Medical Center
Job Category: Strategic Plan/Business Dev
Job Specialty: Managed Care
Position Type: Full-time
Shift Length: 8 hour shift
Shift Type: Day
Base Pay:$25.60 - $38.40
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