Eligibility Specialist

Job description

Overview Job Summary: Provides support to Eligibility Supervisor for all aspects of customer service, account management, and all other administrative projects. This position will act as a partnership role within the eligibility department and will assist in the maintenance of eligibility, EOB’s, DMR’s, ID card printing and maintenance, and other tasks as assigned. Responsibilities: - Act as eligibility department partner; provide resolution for incoming eligibility related issues. To include email correspondence, IT tickets, ACD phone coverage, in person meetings, Team meetings and partner and/or client meetings. - Perform eligibility duties, including the processing and maintenance of daily/weekly eligibility files. - Assist in the monthly distribution of daily, monthly, and quarterly reporting including census reports. - Provide support for bi-weekly and/or monthly eligibility audit process. - Monitor and respond to daily fallout reports and threshold reporting. - BI partnership for escalated items and tasks, as well as the day-to-day data management collaboration. As well as partnering with other operational teams such as Implementation, Benefit Review, BOM, Clinical, ProActPlu...