Senior Representative, Enrollment (Remote)

Molina Healthcare; Phoenix (AZ); Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization in Phoenix is looking for a Senior Representative in Enrollment to manage membership eligibility inquiries and resolve complex issues. The role requires 1-3 years of related experience, strong proficiency in Microsoft Office, and critical thinking abilities. A competitive hourly pay range of $21.16 - $34.88 is offered, depending on experience and education.

Benefits

Competitive benefits and compensation package

Equal Opportunity Employer

Qualifications

• 1-3 years related work experience required.
• Intermediate proficiency in Microsoft Excel and Word.
• Basic knowledge of ANSI X12 834 preferred.

Responsibilities

• Handle membership eligibility inquiries and ensure accuracy.
• Resolve eligibility issues with State or Federal agencies.
• Train new staff and vendors.

Skills

Operational processes to resolve eligibility issues

Critical thinking skills

High volume task management

Communication skills

User testing

Education

Associate degree or equivalent

Bachelor's Degree or equivalent (preferred)

Tools

Microsoft Excel

Microsoft Word

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 a 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 complex eligibility issues and provides resolutions to internal partners, external clients, and regulators.
• Responds, documents, tracks, and quality assures all proceedings with State and/or Federal Agencies, including member complaints, within required SLAs (Service Level Agreements).
• Utilizes critical thinking skills to proactively communicate eligibility issue trends with management.
• Manages high volumes of tasks to support regulatory requirements, service level agreements, and competing priorities.

Contributes to technical system enhancements by performing user testing.

Participates as a team player by assisting peers and management to support department goals.

Trains new staff and 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.
• Supports special projects, including regulatory audits.
• Resolves eligibility exceptions within the required State/Regulatory timeframes.
• Displays initiative to complete assigned tasks timely and accurately, balancing workload to assist peers and leadership.
• Has strong knowledge of enrollment processing for Federal, State, and business regulatory requirements.
• Assists with complex enrollment issues concerning member eligibility.
• Performs quality review and submission of deliverables to Molina Healthcare Government Contract and State Medicaid Agencies.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience.

Required Experience

• 1-3 years related work experience.
• Intermediate proficiency in Microsoft Excel and Word.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience.

Preferred Experience

• 3-5 years related work experience.
• Basic knowledge of ANSI X12 834.

To all current Molina employees: If interested in applying, please do so through the intranet job listing.

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

Pay Range: $21.16 - $34.88 / HOURLY

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