Eligibility Associate Representatives

Immediate need for a talented Eligibility Associate Representatives. This is a 06+months contract opportunity with long-term potential and is located in Baltimore ,MD (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:24-41860

Pay Range: $16 - $16.16/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• 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.

Key Requirements and Technology Experience:

• Key Skills:Medicare, customer service, health insurance.
• Familiarity of/ 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, 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.
• Knowledge of CMS Enrollment & Reconciliation process.
• Knowledge of CMS Billing requirments 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 in a professional manner.
• Ability to adapt in 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).
• High school diploma or GED required, bachelor s degree preferred.
• 3+ years of relevant working experience.

Our client is a leading Healthcare and Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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