Elig & Enrollment Specialist

Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB: The Eligibility and Enrollment Specialist is responsible for receiving, reviewing, processing, and maintaining new member(s) enrollment information. The Eligibility and Enrollment Specialist is responsible for monitoring and working to ensure that member eligibility and enrollment requirements/verifications are in compliance with Health Human Services Commission (HHSC) contractual requirements and Utilization Review Accreditation Commission (URAC) standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration, as required.

General Duties:

• Maintains utmost level of confidentiality at all times.
• Adheres to Health System and Health Plan policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Performs all other tasks as assigned by upper management.
• Adheres to department policies, procedures and guidelines.

EDUCATION AND/OR EXPERIENCE - Any combination of education and experience that would likely provide the required knowledge, skills, and abilities is qualifying.

• Level Experience Knowledge Skills Eligibility and Enrollment Specialist I
• Two-year degree or Associate’s degree; or 1 year related experience and/or training with High School Diploma; or equivalent combination of education and experience.
• Experience with Microsoft Excel and Word. Experience with health insurance and managed care principles.
• Ability to work independently, or in a team environment, toward meeting common goals.
• Integrity and discretion to maintain confidentiality of member and provider data.
• Ability to apply concepts of eligibility and enrollment following established procedures and workflows for completion of assigned tasks.
• Ability to multi-task and meet deadlines in a fast-paced environment.
• Eligibility and Enrollment Specialist II Two-year degree or Associate’s degree; minimum 5 years of related experience and/ or training with High School Diploma; or equivalent combination of education and experience Proficiency with Microsoft Excel and Word.
• Advanced experience with health insurance and managed care principles.
• Experience with insurance eligibility and enrollment concepts.
• Ability to work independently, or in a team environment, toward meeting common goals.
• Integrity and discretion to maintain confidentiality of member and provider data.
• Advanced analytical skills with ability to collect, organize, analyze and disseminate and communicate information with attention to detail and accuracy.
• Ability to multi-task and meet deadlines in a fast-paced environment.
• Ability to access data in varied formats with different methods of analyzing and processing.