Position Title: Eligibility Analyst
Effective Date: August 31, 2011
Reports to: Eligibility Supervisor
Classification: [ ] Exempt (Salaried) [X] Non-Exempt (Hourly)
I. POSITION PURPOSE:
Verifies data to be entered into Choice systems including plan data and member demographic information.
II. MINIMUM QUALIFICATIONS :
A) Education & Experience:
High School Diploma or GED; some college preferred
Some prior experience performing similar work or data entry.
B) Knowledge, Skills and Abilities:
Familiarization with administrative and clerical processes or procedures such as keyboarding, and managing files and information.
Ability to effectively use office technology (Microsoft Office, powerpoint, publisher, outlook, word and excel as well as licensed and proprietary software systems) and general office equipment (printers, faxes, copiers, projectors, phone, etc.)
Knowledge of principles of providing customer service such as needs assessment, and evaluation of customer satisfaction.
Ability to speak clearly to others to accurately convey detailed information.
Ability to write clearly to request or relay detailed information in a professional manner.
Ability to compare similarities, differences and recognize patterns of detailed information; ability to arrange things in a certain order or following a certain pattern according to specific rules.
C) Licensure, Certification or Other Requirements:
Frequent use of personal automobile for conducting business [ ] Yes [X] No
If yes, annual proof of personal auto insurance and annual motor vehicle record check required.
Signed Non-Complete/Non-Solicitation Agreement required? [ ] Yes [X] No
The information below is intended to describe the general nature and level of work required for this position. The information is not to be construed as an exhaustive list of all responsibilities and/or duties required to be successful in the position. Choice reserves the right to add, remove or revise job duties and responsibilities, as well as to reassign employees as demanded by business needs.
III. ESSENTIAL DUTIES (see VII - DEFINITIONS) :
Processes new member enrollment, status changes, demographic changes, and terminations from various source documents.
Prepares, sorts, and keeps track of source documents and data received; identifies and interprets data to be entered. Contacts preparers of the source documents to resolve questions, inconsistencies or missing data. Complies, sorts and verifies the accuracy of the data to be entered.
Enters data into computer system following prescribed format on screen. Compares data entered with source documents or re-enters data in verification format to detect errors. Makes necessary corrections to data entered.
Keeps track of work completed. Reviews error reports and enters corrections.
Transmits entered information into database; files or routes source documents after entry.
Responds to inquiries regarding entered data.
IV. NON-ESSENTIAL DUTIES:
Other duties as assigned.
Serves as back-up to others inside and outside the department.
Staff-shares in other departments as requested.
V. PHYSICAL DEMANDS and WORKING CONDITIONS (see VII - DEFINITIONS):
Work is performed in an indoor, environmentally controlled office environment.
Sedentary working conditions stationed at computer work station with keyboarding activities throughout the day.
Ability to lift, push, pull 20 lbs (such as filing/storage boxes).
VI. OTHER REQUIREMENTS & EXPECTATIONS:
Customer Service: All Choice Strategies employees must deliver the highest level of service (unexpected and over the top) to both internal customers (fellow employees) and external customers (brokers, clients, members, business associates and visitors) on a consistent basis.
Confidentiality: All Choice Strategies employees must protect the confidentiality of all customers, brokers, clients, members, and fellow employees, as well as the confidentiality of all business and proprietary information. All Choice Strategies employees are subject to HIPAA policies and regulations . All employees must sign the Employee Non-Disclosure Agreement.
Compliance: All Choice Strategies employees are responsible for abiding by the policies and expectations outlined in the Employee Handbook. All Choice Strategies employees must sign the Employee Handbook Acknowledgment of Receipt and the Technology Use Agreement.
Essential Duties: In order to comply with the Americans with Disabilities Act (ADA), a determination must be made as to whether duties are considered to be essential or non-essential. Essential duties are key duties that must be performed with or without accommodation. For responsibilities to be considered essential, they must meet one or more of the following requirements:
The performance of this function is the reason the job exists
There are limited employees among whom the performance of this function can be distributed.
This function is highly specialized. Employees are hired for the skill/ability to perform this function.
Failure to perform this function may have serious consequences to Choice Strategies.
Non-Essential duties, while important, do not meet the requirements listed above and can be reassigned to others.
Physical Demands & Working Conditions: In order to comply with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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