Enrollment Data Specialist II - Epic Tapestry & Records

3M HEALTHCARE; Stockton (CA); On-site; USD 35,817 - 39,950; Full time

Job summary

Hill Physicians in Stockton, CA seeks an Enrollment Services Clerk to support data entry and research for member demographics and enrollment in the Epic Tapestry system, ensuring accuracy and timely processing of records.

The role involves maintaining member records, handling enrollment data from multiple sources, resolving issues, and communicating with internal and external staff to obtain information and improve data quality.

Qualifications

• Minimum of one year of experience.
• One year of recent managed-care experience with a heavy emphasis on enrollment using an online system.
• Excellent written and interpersonal communication skills.
• Accurate and detail oriented.
• Demonstrated flexibility and dependability.
• Excellent organizational skills.
• Ability to work independently to meet department turnaround time and performance expectations.
• Working knowledge of CPT, ICD, and MS Office desktop/PC applications.
• Demonstrated ability to exercise good judgment, prioritize multiple tasks, and problem-solve under pressure of deadlines and resource constraints.
• Previous experience with the Epic Tapestry application is highly desirable.

Responsibilities

• Create and maintain member module records, patient demographics, enrollment data, and special handling alerts from both internal and external sources such as HMO member eligibility reports, EDI enrollment queues, and health plan websites.
• Create internal call tracker/CRM requests and route them to appropriate IT departments to resolve member benefit rate code data.
• Research and release internal enrollment pended claims, CRM requests, referrals/authorizations, and other work queues by utilizing the correct member record and assigning appropriate enrollment/coverage.
• Communicate effectively with internal and external staff to obtain client information for problem resolution.
• Research and evaluate health plan enrollment data discrepancies and incoming issues from other departments regarding client information such as current eligibility status, plan information, historical data, and contract/benefit details.
• Determine and execute the best solution to resolve problems.
• Maintain client files and documentation of all research and verified information.
• Set up new member records and flag pertinent records for necessary contract assignments.
• Use multimedia technology to aid in research, including health plan online systems, voice response systems, internet, e‑mail, phone, and fax.
• Perform general administrative duties, including filing, faxing, copying, and mail distribution.
• Prepare necessary paperwork to notify other departments of system changes, such as member moves and changes in PCP status.
• Maintain a 97% accuracy level when entering data.
• Maintain a minimum productivity of 100% and adhere to turnaround times as outlined in department P & P.
• Attend interdepartmental meetings as requested by the Supervisor or Manager.
• Assist with staff training as required.

Skills

Communication skills

Detail oriented

Organizational skills

Independent work

Problem solving under pressure

Education

High School Diploma or GED

Tools

Epic Tapestry

MS Office

Job description

Hill Physicians in Stockton, CA seeks an Enrollment Services Clerk to support data entry and research for member demographics and enrollment in the Epic Tapestry system, ensuring accuracy and timely processing of records.

The role involves maintaining member records, handling enrollment data from multiple sources, resolving issues, and communicating with internal and external staff to obtain information and improve data quality.