Job Description
Job Description
.
The Enrollment Admin Representative is responsible for receiving, assessing and processing enrollment data in accordance with HNE eligibility guidelines, department standards and State and Federal regulations. Maintains membership records in the Amisys database to ensure member information for enrollment and claims processing purposes. Verifies data and responds to internal and external inquiries regarding enrollment eligibility. Provides support to the Enrollment team and Supervisor in the day to day administrative functions related to member eligibility data for internal and external stakeholder.
Essential Functions:
- Makes decision regarding the proper method to enroll, disenroll or change status for all HNE members in Amisys. The enrollment decision is based on the employer’s contact, HNE eligibility guidelines, and plan policies, procedures, and State and Federal guidelines.
- Collaborates with members, employer groups and various internal departments to ensure accurate enrollment of members.
- Communicates with internal departments as appropriate
- Works closely with Sales, Broker and Employer groups to resolve enrollment issues
- Analyzes and resolve eligibility issues received through EDI 834, faxes, emails and phone calls
- Serves as a resource to Member Services for questions related to a member’s eligibility or enrollment status
- Processes enrollments, terms and changes in a timely manner ensuring turnaround times are met.
- Ensures quality of member data and documentation. Continually reviews, edits and maintains member documentation including PHI.
- Audits and reconciles membership data as needed
- Performs other supportive tasks as needed for the Enrollment department.
Minimum Requirements:
High school diploma or equivalent and at least 2 years of data entry experience preferably within the Healthcare industry.
- Strong attention to detail and accuracy
- Very good knowledge of document control and processing procedures
- Very good problem solving and critical thinking abilities
- Very good organizational ability
- Skilled with the Microsoft Office Suite
Working Conditions: Works in a standard office-based environment with long periods of data entry, sitting, viewing computer monitors and utilizing virtual communication tools.