Eligibility Representative

Immediate need for a talented Eligibility Representative. This is a 07+ Months Contract opportunity with long-term potential and is located in U.S.(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:24-30529

Pay Range: $19.50/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:

• Delivers basic technical, administrative, or operative Eligibility tasks. Implements and maintains eligibility for benefits. Implements, updates, and maintains automated, direct connect and/or manual eligibility data by keying information into the system. Interacts with internal partners and/or external clients/vendors.
• Analyses data and reconciles eligibility for accuracy. Researches and resolves problems. Escalates difficult issues. Strong data entry and customer service skills. General product knowledge. Understands simple instructions and procedures.
• Performs Eligibility duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles.
• Responsible for determining plan eligibility and enrolling members within CMS regulatory guidance.
• Work to save members with incorrect/incomplete applications by performing customer, physician and/or agent outreach and using support tools. Maintain member demographic update and membership revalidation and apply eligibility requirements for membership changes.
• Research and respond to eligibility inquiries as needed.
• Ensures all Enrollment eligibility is reconciled and maintained in accordance with CMS and departmental guidelines, requirements, regulations, policies, and procedures.
• This position involves reviewing incoming applications, keying information into systems, determining eligibility, and saving submissions as needed.
• Phone calls to potential customers and Medicaid systems will be made as needed throughout the day. In addition to phone calls, Medicaid websites will be reviewed to gather additional information and eligibility verification on enrollees.

Key Requirements and Technology Experience:

• 1-2 years of data entry and enrolment/eligibility experience highly preferred
• 1-2 years of healthcare experience required.
• Experience with Medicare and state Medicaid highly preferred.
• Candidates with enrolment or eligibility experience will take priority.
• Proficient with Microsoft Office suite products
• Advanced PC Skills required.
• Strong attention to detail
• Critical thinking
• Ability to work with minimal supervision.
• Excellent verbal and written communication skills
• Strong Customer Service skills.
• HS Diploma required.
• Autonomous/Self-motivated Worker
• Analytical Thinker
• Available/willing to work OT as it will be mandatory during busy season.

Our client is a leading Healthcare 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, color, 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.