Under general supervision, assists with tracking and maintaining member eligibility data.
- Verified, maintains and updates members’ coordination of benefit (COB) and dual coverage information in transaction system; researches and corrects errors; maintains archive database.
- Compiles requests for PBM updates; records in transaction system.
- Verifies accuracy of newborn information transferred into tranaction system; corrects and updates newborn member records as required.
- Conducts electronic upload of eligibility files for selected HPSJ programs.
- Updates member eligibility in PBM website.
Required Skills
Required:
- Basic knowledge of principles and practices of accounting for healthcare.
- Basic knowledge of internal audit/control processes.
- Ability to keep records according to established accounting principles and techniques.
- Basic skills in automated transaction systems, including the ability to efficiently enter, upload and extract data and reports.
- Basic analytical and problem-solving skills.
- Produces work that is accurate and complete.
- Produces the appropriate amount of work.
- Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
- Rebounds from setbacks and adversity when facing difficult situations.
- Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
- Ability to read, understand and apply moderately complex written documents.
- Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
- Strong oral and written communication skills, with the ability to communicate professionally and effectively with individuals inside of outside of HPSJ.
- Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
- Ability to collaborate and work as part of a team.
- Strong customer service skills.
- Basic mathematics skills.
- Basic skills in Word and Excel, including the ability to mail merge and sort.
- Ability to speak and be understood in English.
- Ability to treat confidential information with appropriate discretion.
Preferred
- Basic knowledge of the principles and practices of managed care and their application to accounting.
- Basic knowledge of Medi-Cal or other state sponsored programs.
Required Experience
Required
- High school diploma or equivalent; and
- At least two years as an accounting clerk OR
- At least one year as a membership eligibility rep in a healthcare-related setting.
Preferred
- Certificate in Accounting or related.
- Experience in accounting in managed care.
- Experience working with Medi-Cal or other state sponsored programs.