Healthcare Enrollment Verification Specialist Job at Community Medical Services
Overview:
This position will complete verification of client eligibility on various, Medicaid, Medicare & Commercial Provider Portals. Maintain day to day enrollment and demographic processing in Community Medical Services Inc. EHR and EMR for all line of business. Create, update and submit all Demographics to applicable Payers. Research rejected Claims related to member data and resolve discrepancies. Provide necessarily follow up to resolve errors, this would include communication with Operations and Clinical staff. Responsibilities:
Shift: 5:30AM-1:30PM M-F, hybrid 2 days in office, 3 days from home
This position will complete verification of client eligibility on various, Medicaid, Medicare & Commercial Provider Portals. Maintain day to day enrollment and demographic processing in Community Medical Services Inc. EHR and EMR for all line of business. Create, update and submit all Demographics to applicable Payers. Research rejected Claims related to member data and resolve discrepancies. Provide necessarily follow up to resolve errors, this would include communication with Operations and Clinical staff.
- Verification of client eligibility on various, Medicaid, Medicare & Commercial Provider Portals.
- Respond to inquiries, submitted to Departmental Inbox (Microsoft Outlook)
- Maintain day to day enrollment and demographic processing in Community Medical Services Inc. EHR and EMR for all line of business.
- Identify opportunities and recommend actions to improve the efficiency and accuracy of processes.
- Perform audits and analyses on completed member data in core systems
- Create, update and submit all Demographics to applicable Payers.
- Research rejected Claims related to member data and resolve discrepancies.
- Provide necessarily follow up to resolve errors, this would include communication with Operations and Clinical staff.
- High school diploma or equivalent.
- 3+ years of transaction processing, data reconciliation, membership records, or related managed care/healthcare experience.
- Experience in a managed care environment with provider information systems preferred.
- Must be comfortable with reviewing at least 1000k client records a month to validate insurance or client balances.
- Must be comfortable with reviewing client information in the 9 states, where business rules are different.
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