CCSB Eligibility Specialist I

Duties And Responsibilities

• Maintain eligibility for CCPU accounts as assigned including clients that submit eligibility electronically.
• Affix to reviewing and processing all manual and/or Electronic Data Interchange (EDI) enrollment transactions (adds, changes, terminations) in HCPS as received from CCPU, providers, or internal sources in accordance with Participation Agreements, Employer Policy Statements, Eligibility Guidelines and Summary Plan Descriptions.
• Affix to producing electronic spreadsheets and reports for audit and processing purposes.
• Research and correct account application issues in CCPU Portal and HCPS.
• Determine and correct benefit parameters on accounts.
• Contact clients to explain and resolve billing reimbursement discrepancies.
• Verify and authorize refunds for terminations and overpayments.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client and enrollee data.
• Meet processing cycle time standards and production due dates as set forth by management.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
• Create and document a minimum of one new Standard Operating Procedure (SOP) annually.
• Identify, initiate, and implement at least one process improvement and/or innovation annually.

Customer Service Support

• Provide timely and effective Customer Service to clients for requests, inquiries, or issues concerning enrollment and reimbursement items on their accounts.
• Interface effectively with internal departments and external vendors, brokers, or other business contacts to coordinate interrelated activities and resolve eligibility and billing issues as they arise.
• Serve as a representative of CCPU displaying professionalism, knowledge, customer service, and discretion in all interactions with other members of the CCPU community and their customers.

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members.
• Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively.
• Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.

PHYSICAL DEMANDS/WORKENVIRONMENT

• The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls.
• This noise level in the work environment is usually moderate.