Resp & Qualifications
The Medicaid Enrollment Coordinator is responsible for ensuring that all members enrolled in Medicaid plan(s) are reflected accurately in the HealthRules system.
Essential Duties and Responsibilities
- Reconcile the daily 834 MDH eligibility file with the HealthRules system to ensure all members are loaded and reflected accurately in the system.
- Perform daily enrollment updates including new enrollees, newborns, demographic data changes, primary care provider selection and change requests, cancellations and invalidations.
- Maintain and prioritize workload ensuring department performance and turn-around time standards are met.
- Provide thorough and detailed documentation of inquiry issues and resolutions; collaborate with Enrollment team members and other departments to ensure the appropriate solution.
- Handle both outbound and inbound calls courteously, politely and in a professional manner.
- Process department mail (open, sort, validate enrollment status, log receipt of data; re-send if correct address is in HealthRules system).
- Demonstrate strict sensitivity to confidential information and absolute adherence to HIPAA regulations
- Other duties as assigned
Education, Experience and Qualifications
- At least two years’ experience in a healthcare or health insurance environment, familiar with Maryland Medicaid program, and proficient in using the computer as the primary instrument to perform job duties
- Possess an understanding of health care as it relates to enrollment
- Ability to understand and become knowledgeable of standards, policies and procedures, and COMAR regulations to complete work in compliance of these and other standards.
Knowledge, Skills and Abilities
- Excellent written and communication skills
- Must have the ability to multi-task, working swiftly and efficiently without compromising quality and accuracy.
- Proficiency utilizing Microsoft Office, with the priority on Excel.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 3.10.21
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship