CCSB Eligibility Specialist I

About the Role

The Child Care Providers United (CCPU) Eligibility Specialist I performs enrollment and billing functions to maintain CCPU accounts on the CCPU Portal and Healthcare Common Procedure Coding System (HCPS). The role provides high-level customer service support to providers, instructing them on eligibility management and explaining reimbursement issues.

Responsibilities

• Maintain eligibility for assigned CCPU accounts, including clients submitting eligibility electronically.
• Review and process manual and/or Electronic Data Interchange (EDI) enrollment transactions (adds, changes, terminations) in HCPS as received from CCPU, providers, or internal sources, following Participation Agreements, Employer Policy Statements, Eligibility Guidelines, and Summary Plan Descriptions.
• Produce electronic spreadsheets and reports for audit and processing purposes.
• Research and correct account application issues in the CCPU Portal and HCPS, including determining and correcting benefit parameters.
• Contact clients to explain and resolve billing reimbursement discrepancies, verify and authorize refunds for terminations and overpayments.
• Maintain a HIPAA-compliant workstation and use appropriate security techniques to protect confidential/protected client and enrollee data.
• Meet processing cycle time standards and production due dates set by management.
• Identify inefficiencies in established processes and suggest solutions to save time, reduce risk, or reduce expenses.
• Create and document at least one new Standard Operating Procedure (SOP) annually.
• Identify, initiate, and implement at least one process improvement or innovation annually.
• Support providers by facilitating qualifications on time and for the correct reimbursement amount.
• Provide timely and effective customer service for requests, inquiries, or issues concerning enrollment and reimbursement items on client accounts.
• Interface with internal departments and external vendors, brokers, or other business contacts to coordinate interrelated activities and resolve eligibility and billing issues.
• Serve as a professional representative of CCPU, displaying knowledge, customer service, and discretion in all interactions.
• Utilize all capabilities to enhance the competitiveness and profitability of members by being curious, collaborative, and helpful.
• Maintain internet speed of 40 MB download and 10 MB upload with a wired Ethernet router.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• Perform all other duties as assigned.

Work Environment

The employee regularly communicates with others and frequently moves around the office. The role requires the use of tools, objects, and controls. The noise level in the work environment is usually moderate.