Enrollment Specialist job vacancy in Presbyterian Healthcare Services – Jobs in New Mexico

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Job Details
Company Name : Presbyterian Healthcare Services
Company Location : 9521 San Mateo Blvd NE, Albuquerque, NM 87113
Job Position : Enrollment Specialist
Job Category : Jobs in New Mexico

Job Description :

Overview:

The Enrollment Specialist is responsible for maintaining current and accurate membership records by administering contractually defined eligibility and enrollment period guidelines and processing group and member transactions. In addition, Enrollment specialists must be member focused in responding to questions or issues from health plan members and stakeholders regarding insurance benefits and coverage. Responsible for gaining a working knowledge of all federal and state regulatory requirements relative to enrollment and eligibility. Responsible for achieving prescribed department performance standards on a consistent basis.


Type of Opportunity: Full Time

FTE: 1.000000

Exempt: No

Work Schedule: Days

Qualifications:

High school diploma plus one to three years office/business experience; call center experience preferred and/or is currently demonstrating customer service skills, meeting current department metric and attendance guidelines within department. Claims processing experience in managed care with possible enrollment experience is preferred. Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff. Written communication skills as well as business writing and presentation skills are required. Requires strong organizational skills, ability to create, sort and analyze reports (Excel, Access, etc) and system processes. Must be able to type accurately and demonstrate proficiencies in typing skills, 40 wpm with 95% accuracy. Must be able to work closely with other team members and function efficiently under pressure. Must successfully complete Enrollment/Eligibility Specialist competency evaluations. Ability to process information with high levels of accuracy and identify trends.

Responsibilities:

As an Enrollment Specialist you’ll be responsible for entering and maintaining eligibility information for members and groups including:

  • Processing enrollment eligibility, demographic changes, ID card request for various product lines
  • Understanding and administering eligibility/enrollment guidelines including waiting periods, continuation guidelines, maximum age policies, including the student certification process for specified groups.
  • Generating all required member enrollment materials
  • Coordinating the processing of member identification cards
  • Reporting status of Service Level Agreements to Enrollment Leadership
  • Performing at prescribed accuracy and turn around performance goals, 98% Accuracy
  • Troubleshooting and resolving member eligibility inquiries real time

Assists in the development of documentation of process and procedures into functional process improvements to enhance overall level of service to our customers and partners. Uses the Improvement model, identifies patterns in urgent member issues, conducts root cause analysis and reports to management team

Benefits:



We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/employee-benefits/Pages/default.aspx

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers’ markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian’s story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state’s largest private employer with nearly 14,000 employees – including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System
Presbyterian’s Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state’s largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico’s history – and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture – from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it’s all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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