Presbyterian Healthcare Services - Albuquerque, NM

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Minimum Skills/Requirements

High school diploma (or G. E. D.) and a minimum of one year of experience in an office setting required. Prefer at least one year experience with health insurance enrollment background. Must be able to type accurately and demonstrate proficiencies in typing skills, 40 wpm with 95% accuracy.

Requires good organizational skills Demonstrate ability to communicate effectively in person, via telephone and in writing with the public, including members, employers and brokers. Must be able to work closely with other team members and function efficiently under pressure. Must successfully complete Enrollment/Eligibility Specialist competency evaluations. Ability to use office support tools, available at the desktop (example: MS Word, Excel, Email etc)

Ability to process information with high levels of accuracy. Requires basic knowledge of enrollment functions in terms of what and how work is to be done as well as why it is done, this level includes interpretation of data. Requires basic understanding of premium billing, the NM Dept of Insurance managed care guidelines, HIPAA, COBRA, NM Health Insurance Alliance, Conversion and 6-month continuation regulations/requirements.

Knowledge of major production application systems used for delivery of service to internal and external customers. Knowledge of approaches tools techniques for recognizing, anticipating and resolving organizational, operational or process problems.

Primary Job Functions

Responsible for maintaining current and accurate membership records by administering contractually defined eligibility and enrollment period guidelines and processing group and member transactions. Responsible for the administration of all federal and state regulatory requirements relative to enrollment and eligibility. Responsible for achieving prescribed department performance standards on a consistent basis.

Processes enrollment eligibility data for ASO and Commercial product lines.

Administers eligibility/enrollment guidelines including multiple groups waiting periods and maximum age policies, including the student certification process for specified groups. Process payment/banking information on specified groups or individuals.

Generates all required Enrollment letters that have been approved by Pres Connect.

Coordinates the processing of member identification cards.

Responsible for reporting backlog/status to Enrollment or Manager.

Responsible for consistently performing at prescribed accuracy and turn around performance goals, 98% Accuracy.

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