The Member Processing Specialist will be responsible for providing ongoing support to the MPC leadership team through various tasks.
Understand company policies as they apply to Choice Administrators.
Review, understand, quality control and process enrollment materials with a high level of accuracy (i.e. Employee applications, change requests, terminations, appeals, corrections, etc).
Initiate clear and concise pending item requests to obtain missing or incomplete information via phone, fax or email.
Ability to explain all eligibility requirements and procedures to internal and external customers.
Provide clear and concise correspondence in and outside of the department (i.e. denials, confirmations, memos, letters, etc).
Identify and recommend system enhancements and areas of improvement.
Assist with system testing.
Create and revise guidelines, instruction files and workflows.
Create and maintain productivity reports as needed.
Create templates, maintain forms and letters as needed in Word, Outlook and Excel.
Maintain knowledge of all products and systems used (i.e., Pegasus, Doclink, SharePoint, etc).
Develop and adhere to all PHI (Personal Health Information) and HIPAA guidelines.
Keeps management informed about problems and recommends and implements solutions.
Meet department standards for quality and quantity of work.
Assist with departmental training needs as assigned by leadership team. Assist as a back up to Data Entry, Correspondence, Delegation and Eligibility.
Special projects and duties as assigned.
Educational Requirements -
Graduation from a 4 year college or university or a level of education that, together with experience and training, enables the applicant to demonstrate the required knowledge and experience .
Completion of development courses in professional training skills is a plus.
Knowledge, Skills & Abilities Required -
Open and clear communicator with excellent communication and presentation skills (written, grammatical, verbal, developmental)
Ability to interact and communicate effectively with all levels of employees and clients.
A track record for meeting deadlines.
Excellent customer service skills.
Able to build/gain commitment and overcome resistance to change.
Ability to work well in a fast-paced professional office environment.
Knowledge of the healthcare industry
Proficient with Microsoft Office software (Access, Word, Excel, PowerPoint, Visio, Publisher, SharePoint, Outlook), web based technology.
Ability to retain large quantities of information.
Must be able to handle multiple tasks at one time.
Typing of 50 WPM.
Word & Brown Companies - 11 months ago
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