Senior Representative, Enrollment (Remote)

Molina Healthcare; City of Rochester (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare company is seeking a Sr Rep, Enrollment to manage membership eligibility inquiries and ensure accuracy within the system. The ideal candidate will have strong analytical skills and experience in enrollment processing. This position offers a competitive hourly rate ranging from $21.16 to $34.88. The role requires collaboration with external clients and internal partners to effectively handle membership issues.

Benefits

Competitive benefits and compensation package

Equal Opportunity Employer

Qualifications

• 1-3 years related work experience required.
• 3-5 years related work experience preferred.
• Strong knowledge of Enrollment processing for Federal, State, and business regulatory requirements.

Responsibilities

• Handles membership eligibility inquiries and ensures accuracy.
• Analyzes complex eligibility issues and provides resolutions.
• Trains new staff on assignments and regulatory requirements.

Skills

Critical thinking

Communication skills

Interpersonal skills

Data reconciliation

Education

Associate degree or equivalent

Bachelor's Degree or equivalent

Tools

Microsoft Excel

Microsoft Word

ANSI X12 834

Job description

JOB DESCRIPTION

Job Summary

The Sr Rep, Enrollment handles all processes related to membership eligibility inquiries and ensures membership accuracy within the system. Represents Enrollment Operations as a subject matter expert (SME) and works collaboratively with external clients and internal partners to resolve membership issues. Utilizes multiple applications and has deep understanding of eligibility related processes.

KNOWLEDGE/SKILLS/ABILITIES

• Completes operational processes to resolve eligibility issues including but not limited to incoming/outgoing eligibility

• Reconciles eligibility information with State or Federal Agencies using varied methods.

• Analyzes and assist with complex eligibility issues and provides resolution to internal partners and external clients. and regulators

• Responds, documents and tracks and quality assures all proceedings with State and/or Federal Agencies. (including member complaints) within required SLAs (Service Level Agreements)

• Utilize critical thinking skills to proactively communicate eligibility issue trends with Management.

• Manages high volumes of tasks to support regulatory requirements and service level agreements and competing priorities.

Contributes to technical system enhancements by performing user testing.

• Participate as a team player by assisting peers and Management to support department goals.

• Trains new staff on assignments and/or vendors on assignments

• Serves as the Subject Matter Expert (SME) to support production and provides knowledgeable responses to internal and external inquiries regarding eligibility, ID cards, selection of primary care provider, and state enrollment transactions.

• Prioritizes daily, weekly and monthly job tasks to support regulatory requirements and service level agreements.

• Support special projects including regulatory audits

• Resolves the following eligibility exceptions within the required State/Regulatory timeframes.

• Displays initiative to complete assigned tasks timely and accurately and balances workload to assist peers and leadership team.

• Strong knowledge of Enrollment processing for Federal, State, and business regulatory requirements.

• Assist with complex enrollment issues concerning member eligibility.

• Quality review and submission of deliverables to Molina Healthcare Government Contract and to State Medicaid Agencies.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experiences

Required Experience

• 1-3 years related work experience

• Intermediate Microsoft Excel and Microsoft Word

Preferred Education

Bachelor's Degree or equivalent combination of education and experiences

Preferred Experience

• 3-5 years related work experience

• Basic knowledge ANSI X12 834

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.16 - $34.88 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.