Molina Healthcare
Senior Representative, Enrollment (Remote)
This job is now closed
Job Description
- Req#: 2032139
- 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.
- 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.
- 1-3 years related work experience
- Intermediate Microsoft Excel and Microsoft Word
- 3-5 years related work experience
- Basic knowledge ANSI X12 834
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
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
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experiences
Required Experience
Preferred Education
Bachelor's Degree or equivalent combination of education and experiences
Preferred Experience
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.
About the company
Molina Healthcare is a managed care company headquartered in Long Beach, California, United States.
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