Job Description

  VOCA has an immediate opening  available for  Enrollment Specialist professionals in COSTA MESA, CA! If you have 2 years of Customer Service experience this is a great opportunity to get your foot in the door with one of the leading hospitals in California.  POSITION DETAILS  ENROLLMENT SPECIALIST JOB DESCRIPTION

• Our client is seeking an Enrollment Specialist (Customer Service) responsible for answering phone calls from health care providers, health plans and members on inquiries related to enrollment, eligibility and authorization. The Enrollment Specialist will ensure first-call standards are followed, will refer and follow up as per Clinic MSO guidelines.
• Assist with resolving telephone calls from customers on inquiries related to enrollment, eligibility, authorization by accurately identifying customer needs and taking appropriate action
• Follow Clinic MSO guidelines and policies ensuring compliance with regulatory guidelines and health plan requirements
• Document all incoming calls following HIPAA guidelines in handling patient data
• Assist in identifying and reporting issues working with the Claims and Enrollment management team to help minimize re-work and address front-end process issues
• Interact in a positive and collaborative manner with internal and external partners especially in demanding and tense situations with providers and patients exhibiting a caring, empathetic, and patient attitude
• Analyzes data from several sources to determine eligibility changes and resolve enrollment or eligibility errors
• Reconciles transactions create and processes corrections and disputes
• Assures compliance with operational and regulatory requirements for all enrollment and eligibility operations
• Assist in provider customer service, member services, health plan, and other customers including making and answering phone calls to provider or members when necessary based on team guidelines
• Engages in membership eligibility research, requiring critical thinking skills and the ability to analyze and resolve discrepancies
• Engage with providers, health plan partners, and internal departments to resolve eligibility issues
• Work with cross-functional departments by providing support to IPA/PCPs as necessary; with an emphasis on front-line eligibility problem solving.
• Perform support and other duties as needed.

  QUALIFICATIONS

• Required
  • Minimum of 2 years of customer service experience
  • High school diploma or general education degree
  • Excellent communication, organizational, and interpersonal skills
  • Ability to work independently and use critical thinking skills
  • Strong moral compass and commitment to our client’ s values
  • Motivated to learn, continually improve and operate to one’ s fullest potential
  • Positive attitude, passionate, excited, strong desire to simplify processes
  • Experience in providing excellent customer service, empathetic ability
  • Basic knowledge of Managed Care Plans, Medi-Cal Managed Care Plans, and private insurance
  • Proficient using Microsoft Office applications
• Preferred:
  • Knowledge of Medicare Managed Care Plans
  • Bi-lingual (English/Spanish) preferred
  • Typing skills 40-50 wpm

SHIFT

• M-F 8am  - 5pm

Interested in learning more about this Enrollment Specialist opportunity? Apply today!  VOCA: THE SPIRIT OF WORK   IND-PF