Enrollment Specialist (Remote)

Vaya Health; North Carolina; Remote; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a detail-oriented individual for a remote position focused on managing client data and benefit plans. This role involves ensuring accurate submissions from providers, collaborating with various departments on eligibility issues, and maintaining compliance with healthcare regulations. The ideal candidate will have a strong background in Medicaid and Medicare, along with excellent customer service skills. Join a team dedicated to making a difference in healthcare while working from the comfort of your home. If you thrive in a dynamic environment and are passionate about supporting clients, this opportunity is for you.

Qualifications

• 2+ years' experience with Medicaid, Medicare, and customer service.
• Proficiency with data management software and compliance requirements.

Responsibilities

• Ensure client data and benefit plans are accurately submitted.
• Coordinate with Claims Department on eligibility and enrollment issues.

Skills

Data Management

Attention to Detail

Customer Service

Medicaid and Medicare Knowledge

Education

High School Diploma or GED

Tools

NC Tracks Database

Consumer Data Warehouse (CDW)

Job description

LOCATION: Remote -This is a home based, virtual position that operates on US Eastern Standard Time within the hours of 8:30am-5:00pm. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

GENERAL STATEMENT OF JOB

This position will ensure that all client data and benefit plan information is correct and properly submitted to Vaya Health from providers; enroll consumers into the state benefit plan when requested and appropriate. This position coordinates with the Claims Department around denials related to eligibility of consumers and works with the Access Team on eligibility and enrollment issues. This position will process both provider and auto-generated discharges. Processing of customer service update requests will also be managed with this position. The NCSNAPS database will be managed with coordination between providers and other Vaya departments.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONS

Eligibility & Enrollment Data Entry, Review and Correction:

This position will ensure that all client data and benefit plan information is properly submitted to Vaya from the providers and the state's NC Tracks Database. This position will review and manage discharges, Client Update Requests, Enrollments and NCSNAPS information. This position will interact with providers and internal units in a professional manner as evidenced by no complaints or grievances and through supervisor's observation.

Collaboration with other Vaya Departments:

This position will coordinate with the Claims Department around claim denials related to eligibility of a consumers, and work with the Vaya Access Team on eligibility issues and enrollment issues.

Other duties as assigned.

KNOWLEDGE, SKILL & ABILITIES

This position is required to have extensive knowledge of multiple systems used by NC DHHS, including but not limited to NC Tracks and the states Consumer Data Warehouse (CDW) or any alternate systems deemed applicable by NC DHHS. Staff must be proficient with requirements related to data component formats, submission reports and processes and compliance. Proficiency with data management software is also crucial in order to assure competent completion of assigned tasks. Strong attention to detail and data accuracy is also required for this position.

QUALIFICATIONS & EDUCATION REQUIREMENTS

High school diploma or GED with at least 2 years' experience with Medicaid, Medicare and other 3rd party payment sources. Prior experience with member enrollment and customer service in an MCO and/or experience in the mental health field are highly desired due to the complexity of the work of the organization.

PHYSICAL REQUIREMENTS:

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: Must live in NC, SC, GA, TN, VA, MD, or FL.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled.

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.