Member Processing Specialist
Word & Brown Companies - Orange, CA

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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 and analysis.
• Create processes and revise guidelines, instruction files and workflows for new guidelines and regulations.
• Create productivity reports.
• Develop and maintain training materials as well as training presentations.
• 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)
• Strong project management skills
• 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 - 30+ days ago - save job - block
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