The Eligibility Consultant is a full time office based position. Offices are temporarily closed due to COVID 19; consequently, this position will telework from home temporarily until the office reopens.
This position under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data.
At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. Were a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. In April 2021 were going to begin delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, lets work together to make a difference and improve the health and wellbeing of Arizona.
* Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
* Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
* Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors.
* Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.
* Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.
* Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information.
* Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
* Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
* Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity. Utilizes and interprets online resources to understand customers account structure and benefits. May assist with the development of such resources. Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services. Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
* Ability to analyze and research data to make appropriate corrections as necessary.
* Understands the impact of work to other teams and downstream support areas.
- Work week is Monday through Friday; anticipated shifts are 8am to 5pm and 9:30am to 6pm. Qualified candidates must be flexible and able to work both shifts as assigned.
- Strong verbal and written communication skills.
- Sound understanding of system errors and how to resolve efficiently.
- Strong organization skills.
- Problem solving skills.
- Attention to detail and accuracy.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
- Strong data entry skills
Medicaid experience a plus
High school diploma or GED
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.