Eligibility Specialist I
Posted on Mar 10, 2019 by Beacon Health Options
MI: Grand Rapids
We are currently seeking a dynamic Eligibility Specialist I to join our team at our office in Grand Rapids, MI!
About the Position:
We are currently seeking a dynamic Eligibility Specialist I to join our team at our office in Grand Rapids, MI! The Eligibility Specialist I reviews/verifies member eligibility and ensures member eligibility is accurately represented in the Connect Administration System (CAS) for all clients across all divisions.
The incumbent interacts with clients, internal/external client contacts and business systems analysts to investigate and resolve eligibility issues. The incumbent is responsible for administrative evaluation, completion, and correction of authorizations and reviews in relation to clinical contract requirements
- Respond to eligibility and authorization inquires and completes manual eligibility requests within the agreed client and company performance expectations to ensure that all internal and contractual performance expectations are met. This includes meeting the production standard as indicated in the performance standards for this level.
- Update and maintain member records in the CAS system in an accurate manner while meeting the quality standard as indicated in the performance standards for this level.
- Verify eligibility status utilizing external web portals, client contacts and databases.
- Review and resolve eligibility errors resulting from files loads as assigned by the Technical Advisor.
- Communicate system/client irregularities/error trends to the Technical Advisor.
- Maintain tracking and trending spreadsheets or databases related to receipts of eligibility
- Participate in process improvement workgroups.
- Perform administrative evaluation, completion, and correction of authorizations and reviews in relation to clinical contract requirements.
- Create/update inquiries into the CareConnect/ServiceConnect application and route to the appropriate clinical department for decision making as necessary.
- Perform other job related duties as dictated by business needs.
- Education: Bachelor's Degree in business or related experience is preferred. High School Diploma or equivalent required.
- Relevant Work Experience: Two (2) years of (health preferred) insurance experience in a Claim, Eligibility and/or Customer Service environment, with a concentration in a technical or analytical position, or other equivalent experience is required.
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.
AAP Reporting Location:
ID (Req #):
40 hours per week