JOB SUMMARY:

Position Title: Enrollment Data Specialist

The Enrollment Data Specialist performs operational solutions to optimize membership enrollment and premium billing accuracy and collaborates and supports internal and external customers. This position researches and reconciles systemic eligibility/enrollment or premium billing /payment discrepancies to arrive at a consistently compliant disposition and operates in a fast-paced environment with frequent priority changes. The Enrollment Data Specialist is held responsible for understanding and abiding by State, Federal, and organizational guidelines for various lines of business related to Membership enrollment and reconciliation.

30% Determine Member's eligibility and process request according to regulatory guidelines. Eligibility Extract and account billing analysis.
20% Performs research and resolves errors/ discrepancies related to transactional data within internal systems
20% Submission of enrollment and eligibility disputes to regulatory entity Completion of internal case inquiries: enrollment and/or billing Reconciliation of accounting and membership data to align with regulatory entity.
10% Processing account refunds
10% Responsible for staying up to date with the latest communications, regulatory requirements, industry best practices, and guidance provided by regulatory entity
10% Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans and other duties as assigned.
100%

Minimum Qualifications:

Education/Specialized Training/Licensure:
* High School Diploma

Work Experience:
* Two (2) years related experience with health insurance, managed care, or customer service.
* Knowledge of eligibility files /premium billing, Medicare preferred.
* (Medicaid/ Chip- with Star kid- familiarity highly preferred.)
* Knowledge of reconciliation and Analysis of reports
Software Proficiencies:
* Advanced Experience of Excel- (Pivot tables working knowledge - preferred).
* Microsoft Office (Word, Excel, and Outlook), SQL a plus

COMPETENCIES

Organizational Core Competencies:

All employees are responsible for understanding and demonstrating Community Health Choice core competencies:
* Customer Focus - Sustainability
* Reliability and Dependability - Employee Empowerment
* Honesty & Integrity - Sustainability
* Change Management - Affordability
* Teamwork - Employee Empowerment

Job Competencies:

* Problem Analysis
* Attention to Detail
* Above Average Verbal
* Exceptional Verbal