Eligibility Research Rep I (Remote, $15/hr)

Responsibilities

• Researches and resolves member eligibility requests.
• Maintain a minimum production level of 85 claims, 60 CSS/MNA, or 60 ASHLink requests per day pro-rata with no less than 98% accuracy.
• Ability to assist in multiple functions as needed.
• Ability to participate in peer mentorship as needed.
• Eligibility Research Verification: Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected.
• Verifies member eligibility from eligibility file, communications log, and health plan websites or by calling the health plan directly when all other resources are exhausted.
• Inputs and saves verified member’s information into the communications log and/or member maintenance.
• Ensures the highest quality of customer service by maintaining a professional and courteous manner.
• MNA Research: Processes research immediately to ensure same day turnaround time is met.
• Completes research and returns ASHCore log to MNA bucket.
• Customer Service Research: Processes research same day to ensure 24 hour turnaround time is met.
• Makes follow up calls same day to providers and members to give results of research.
• Transfers providers to provider queue if question is not related to eligibility.
• Transfers members to member queue if caller has detailed questions or wishes to file a complaint.
• Updates member and group records as needed.
• Solves ASHCore log when process is completed.
• Claims Research: Processes research within 24 hours to ensure 48 hour turnaround time is met.
• Builds or updates member and group records in IHIS including documentation in notes.
• Creates ASHCore log and resolves whenever a health plan call is made.
• ASHLink Research: Processes research within 24 hours to ensure 48 hour turnaround time is met.
• Creates ASHCore logs and resolves whenever a health plan call is made.
• Completes ASHLink logs by responding to providers when research is complete.
• Attends staff and other meetings to discuss issues and foster teamwork among department personnel.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• A high school diploma or GED certificate required.
• One year of experience with 10 key, typing, and computer skills.
• 8,000 key strokes per hour required.
• Experience with claims processing or eligibility verification preferred.
• Excellent customer service skills, with experience making outbound calls and meeting expectations for productivity and accuracy.