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WI-Dean Health Plan 1277 Deming
Determines applicant eligibility for enrollment and continuation or extension of coverage in accordance with contracts, member certificate, and other regulatory entities. Provides eligibility information and acts as a liaison for enrollment and eligibility issues. Reconciles enrollment related discrepancies.
Job Responsibilities and Requirements:
- Reviews enrollment applications to determine initial and ongoing eligibility of individuals for coverage according to applicable contracts.
- Processes quality assurance and error reports to ensure appropriate coverage for members.
- Prepares and adjudicates member and group accounts for billing; and prepares statements on a monthly and quarterly basis.
- Identifies and escalates problems and opportunities to the manager.
- Maintains compliance with internal and regulatory standards.
- Initiates billing and enrollment adjustments and coordinates reconciliation of billing problems with accounts receivable staff.
- Answers and assists customer matters with internal departments and external groups.
- Provides back-up support to the enrollment and billing staff as needed.
- Performs other duties as assigned.
- High school diploma or equivalent
- Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
- Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
- Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
- Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
- Frequent keyboard use/data entry.
- Occasional bending, stooping, kneeling, squatting, twisting and gripping.
- Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
- Rare climbing.
Day Shift (United States of America)Job Type:
97230188 700445-Enrollment and BillingScheduled Weekly Hours:
SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.
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