CCSB Eligibility Specialist I

Description

Job Description Summary

Qualifications

• High school diploma or equivalent and one (1) to three (3) years of Accounting/Business experience with knowledge of generally accepted accounting procedures, analytical abilities or equivalent combination of education and experience preferred.
• Knowledge of generally accepted health care eligibility and billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), California Continuation Benefits Replacement Act (Cal-COBRA) and Employee Retirement Income Security Act (ERISA) legislation.
• Strong computer aptitude with Word, Excel and Outlook and the ability to develop a strong proficiency working with a proprietary Health Care system.
• Experience providing Customer Service to a variety of client contacts via email and telephone.
• Ability to research and resolve technical issues and/or client problems as they arise with minimal direction.
• Proficient written and oral communication skills to include modern business communications, formatting of professional letters, reports and phone etiquette.
• Skills to establish priorities, multi-task, work under pressure and deadlines, work independently with minimal supervision or in team environment.
• General knowledge of health insurance operations and industry.
• Spanish bilingual (verbal/written) abilities a plus.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

Duties And Responsibilities

• Assist in maintaining Eligibility and Billing for CCSB accounts as assigned including clients that submit eligibility electronically.
• Assist in reviewing and processing all manual and/or Electronic Data Interchange (EDI) enrollment transactions (adds, changes, terminations) in HCPS as received from the client or internal sources in accordance to Participation Agreements, Employer Policy Statement, Eligibility Guidelines and/or Summary Plan Descriptions.
• Assist in producing electronic spreadsheets and/or reports for audit and processing purposes.
• Research and correct cash application issues in HCPS. Determine/correct out of balance ledger items on accounts. Contact clients to explain and to resolve billing/payment discrepancies. Verify/authorize refunds for terminations and/or overpayments.
• Maintain a HIPAA compliant work station and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client and enrollee data.
• Consistently meet processing cycle time standards and production due dates as set forth by management.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
• Create and document a minimum of one new Standard Operating Procedure (SOP) annually.
• Identify, initiate and implement at least one process improvement and/or innovation annually.

• Assist in supporting with clients to facilitate payments on time and for the billed amount.
• Provide timely and effective Customer Service to clients for requests, inquiries or issues concerning enrollment and/or billing items on their account.
• Interface effectively with internal departments and external vendors, brokers or other business contacts to coordinate interrelated activities and to resolve eligibility and/or billing issues as they arise.
• Serve as representative of CCSB displaying professionalism, knowledge, customer service and discretion in all interactions with other members of the CCSB community and their customers.

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• Other duties as assigned.

Physical Demands/Work Environment