Job Description
Job Description
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
What You Will Be Doing:
Under general supervision, assists with tracking and maintaining D-SNP (Dual Special Needs Plan) member enrollment data.
Our Vision:
Continuously improve the health of our community.
Our Mission:
We provide healthcare value and advance wellness through community partnerships.
Essential Functions:
- Review and process enrollment requests promptly, ensuring accuracy and adherence to CMS and other Managed Care Guidelines.
- Maintain the accuracy and timeliness of acknowledgment notices sent to members following enrollment submissions.
- Establish and maintain membership data; manage timely and accurate processing of files to ensure all systems have correct data.
- Ensure meticulous completion of enrollments, including processing DSNP enrollment, disenrollment, cancellation requests, reinstatements, and maintaining comprehensive reconciliation files.
- Perform daily reconciliation tasks, including reconciling Transaction Reply Reports (TRRs) and retro reconciliation files to ensure data integrity.
- Foster effective communication channels with various departments to address and resolve member issues promptly and efficiently.
- Develop a thorough understanding of enrollment operations, including DSNP membership enrollment, reconciliation processes, and benefits coordination operations.
- Uphold quality and compliance standards to meet applicable guidelines, ensuring all submissions to CMS – Medicare are timely, accurate, and complete.
- Provide support in preparing for audits and responding to data requests, maintaining meticulous records and documentation.
What You Bring:
Knowledge, Skills, Abilities and Competencies
Required
- Basic knowledge of principles and practices of accounting for healthcare.
- Basic knowledge of internal audit/control processes.
- Ability to keep records according to established accounting principles and techniques.
- Basic skills in automated transaction systems, including the ability to efficiently enter, upload and extract data and reports.
- Basic analytical and problem-solving skills.
- Produces work that is accurate and complete.
- Produces the appropriate amount of work.
- Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
- Rebounds from setbacks and adversity when facing difficult situations.
- Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
- Ability to read, understand and apply moderately complex written documents.
- Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
- Strong oral and written communication skills, with the ability to communicate professionally and effectively with individuals inside of outside of HPSJ.
- Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend a broader range of activities. Meets deadlines.
- Ability to collaborate and work as part of a team.
- Strong customer service skills.
- Basic mathematics skills.
- Basic skills in Word and Excel, including the ability to mail merge and sort.
- Ability to speak and be understood in English.
- Ability to treat confidential information with appropriate discretion.
Preferred
- Hands-on experience with 834 EDI, State (CA DHS), and CMS files
- Basic knowledge of the principles and practices of managed care and their application to accounting.
- Basic knowledge of Medi-Cal or other state sponsored programs.
What You Have:
Education and Experience
Required
- High school diploma or equivalent; and
- At least two years as a data entry clerk; or
- At least one year as a membership eligibility rep in a healthcare-related setting
Preferred
- At least two years’ experience in a Medicare health plan or Managed Care - Enrollment, Disenrollment and Reconciliation
- Robust knowledge of Medicare and CMS enrollment.
- Certificate in Accounting or related.
- Experience in accounting in managed care.
- Experience working with Medi-Cal or other state sponsored programs.
Licenses, Certifications
None
What You Will Get:
HPSJ Perks:
- Competitive salary
- Robust and affordable health/dental/vision with choices in providers
- Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
- CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
- Two flexible spending accounts (FSAs)
- Employer-Paid Term Life and AD&D Insurance
- Employer-Paid Disability Insurance
- Employer-Paid Life Assistance Program
- Health Advocacy
- Supplemental medical, legal, identity theft protection
- Access to exclusive discount mall
- Education and training reimbursement in addition to employer-paid elective learning courses.
- A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
- A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
- Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.