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CCSB Eligibility Specialist I

Remote:

Full Remote

Salary:

34 - 49K yearly

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

High school diploma or equivalent., 1-3 years of Accounting/Business experience., Knowledge of health care eligibility and billing procedures., Strong computer skills with Word, Excel, and Outlook..

Key responsabilities:

Maintain Eligibility and Billing for CCSB accounts.
Provide customer service support regarding eligibility management.

Western Growers Family of Companies Non-profit Organization - Charity SME https://www.wga.com/

201 - 500 Employees

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Job description

Description

If you’re looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we’re looking for you.

At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full-suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.

As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn’t a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee’s life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.

With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees’ job satisfaction and success.

Compensation:$34,095 - $49,323 with a rich benefits package that includes profit-sharing.

Job Description Summary

The CCSB Eligibility Specialist I is responsible for performing enrollment and billing functions necessary to maintain Covered California for Small Business (CCSB) accounts on the Healthcare Common Procedure Coding System (HCPS) as assigned. The role is also responsible for providing the highest level of customer service support to clients by instructing them on correct eligibility management and explaining billing/payment issues.

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

Process Management & Maintenance

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.

Customer Service

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.

Other

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

The physical demands and work environment described here represent those that an employee must meet to perform this job’s essential functions successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.