Johnson Service Group has immediate openings for Eligibility Specialists. These positions are fully remote- Must Live in California.
Hours: 7am-4pm with some OT and some Saturdays 6am-12pm
Salary: $18.50 per hour
Qualifications:
- High School diploma or equivalent or three (3) to five (5) 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.
- Intermediate computer experience with Microsoft office with intermediate knowledge of Excel spreadsheet manipulation to produce audit files and reports.
- Strong ability to develop proficiency working with a proprietary health care system.
- Knowledge of processing Electronic Data Interchange (EDI) file updates in a legacy system.
- Experience providing customer service to a variety of client contacts via email and telephone.
- Demonstrated ability to research and resolve technical issues and/or client problems as they arise with minimal direction.
- Written and oral communication skills including modern business communications, formatting of professional letters, reports and phone etiquette.
- Demonstrated time management skills including, multi-tasking, working under pressure and deadlines, and working independently with minimal supervision or in team environment.
- General knowledge of health insurance operations and industry.
- Bilingual-Spanish verbal/written abilities a plus.
Duties and Responsibilities:Process Management & Maintenance
- Maintain Eligibility and Billing for accounts as assigned including clients that submit eligibility
- Review and process all manual and/or 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.
- Produce 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
- Work 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
- Plan and execute work in a helpful and collaborative manner.
- All other duties as assigned.
** Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law. #D800