Patient Care Representative
: Job Details :

Title: Eligibility Associate Representative

Location: Remote in (EST and CST)

Duration: 06 Months (potential to extend if the project continues)

Shift Hours: 8:30 am-5:00 pm EST

Quick notes/highlights:

• Familiarity with/ having a basic knowledge of Medicare will be helpful for these candidates.
• Customer service experience that has exposure to insurance or Medicare will be helpful.
• They will be trained in a few parts of the team and deployed as needed to support different branches of the team
• Need to have basic computer skills. These candidates need to know how to navigate different screens and programs.
• Need to have basic Microsoft Office/Excel skills and experience
• High-volume work. When they log in, they will be assigned a queue of what they need to work on
• They will receive Q-Net and Medicare training and will learn how to process the records they receive in their queues
• Some candidates might have to be on the phone more than others depending on the team they are placed on.

Duties:

• Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect, and/or manual eligibility data.
• May handle reconciliation for non-standard requests. May provide technical support for the electronic procession of eligibility.
• Ensures customer data is installed accurately and timely.
• Technical knowledge of manual and automated eligibility.
• Completes day-to-day Eligibility tasks without immediate supervision but has ready access to advice from more experienced team members.
• Tasks involve a degree of planning and anticipation of needs/issues.

Essential Functions:

• Facilitates accurate processing of Enrollment applications to ensure timely input and acceptance to CMS.
• Performs account benefit verification requiring complex decision skills based on payer and process knowledge resulting in proper access to care.
• Process Reconciliation files from CMS to include Disenrollments, Late Enrollment Penalties and Low Income Subsidies
• Timely and Accurate processing of monthly Premium payments including identification and processing of write offs, resolution of credit balances and posting of payments to member accounts
• Process Coordination of Benefits and Medicare Secondary Payer files from CMS to meet Federal and State Regulatory guidelines.
• Ensure accuracy of data entry to allow for meeting proper Service Level Agreements
• Use discretion & independent judgement in handling more complex cases and be willing to learn new skills within the Enrollment Functions
• Directly interfaces with other teams within Client
• Provide support to other internal functions as needed.
• May need to be proficient in Multiple Systems
• Completes other projects and additional duties as assigned.

Top 3 Skills:

• Analytical skills
• Customer Service Skills
• Quick Learner

Other Skills:

• Knowledge of the CMS Enrollment & Reconciliation process
• Knowledge of CMS Billing requirements and regulations
• Knowledge in Coordination of Benefits and Medicare Secondary Payer
• Medicare Part C and Part D
• Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• Excellent presentation and communication skills.
• Demonstrated ability to handle challenging interactions professionally.
• Ability to adapt to a dynamic work environment and make decisions with minimal supervision.
• Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
• SQL (a plus not required)

Education:

• High school diploma or GED required, bachelors degree preferred.
• 3+ years of relevant working experience.

About Us: Established in 2004, SPECTRAFORCE is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of human connection, defined by our branding attitude of NEWJOBPHORIA, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at:

Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at ...@spectraforce.com if you require reasonable accommodation.

California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (CPRA) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting ...@spectraforce.com.

LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.

At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This positions starting pay is: $16.00/hr.