Enrollment and Eligibility Representative

Job Details

Job Description

Essential Functions:

• Able to work in a constant state of alertness and safe manner
• Research and correct eligibility discrepancies identified through error reports
• Update member demographic and eligibility information on the membership eligibility system in response to requests from other business areas
• Reconcile member eligibility data to ensure internal systems match State and Federal information
• Identify HPP newborns based on specified departmental processes and update internal systems accordingly
• Research Third Party Liability reports and updated internal systems accurate information
• Analyze eligibility information in DHS, Utilization Management and Eligibility vendor systems to determine enrollment status and information on other insurance
• Validate eligibility requirements associated with new enrollments, disenrollments, demographic changes, and benefit package changes
• Communicate enrollment discrepancies to State and Federal agencies or their designates

Education:

• High School Diploma or equivalency required.
• 1-2 years of experience in managed care or healthcare insurance environment is recommended.

Skills/Abilities (preferred):

• Ability to maintain strict confidentiality of applicant information in performance of job functions.
• Demonstrated ability to organize work efficiently, to evaluate and establish priorities, to handle multiple projects simultaneously.
• Demonstrated ability to receive direction, to exercise judgment and make appropriate decisions in the handling of confidential and time sensitive documents and information.
• Able to present oneself in a professional manner when dealing with public contacts and internal staff.
• Able to express oneself clearly and concisely both verbally and in writing.
• Proven experience with Microsoft Office products
• Experience in Medicaid, Medicare and/or CHIP eligibility process highly beneficial.

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.