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MMIC Eligibility Consultant - Electronic - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | phoenix, Arizona |
About this job
This is an in-office position in Phoenix, AZ.
POSITION SUMMARY
Process accurate and timely eligibility into Aetna Systems utilizing Aetna policy guidelines and in accordance with key performance measures and first claim/first call resolution. Provide Plan Sponsors with accurate bills and members with timely and accurate ID cards and audit cert lists. Improvement of financial results by reducing losses associated with non-payment. Ensures collected reconciled dollars are allocated across benefits and structure. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data.
Fundamental Components:
Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors.
Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.
Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.
Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information. Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity.
Utilizes and interprets on line resources to understand customers account structure and benefits. May assist with the development of such resources.
Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.
Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
Additional information:
Sound understanding of system errors and how to resolve efficiently.
Strong verbal and written communication skills.
BACKGROUND/EXPERIENCE
Additional Information (situational competencies, skills, work location requirements, etc.)
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Administration / Operations/Data Entry/1-3 Years
Functional - Customer Service/Customer service - production environment/1-3 Years
TECHNOLOGY EXPERIENCES
Microsoft Outlook/1-3 Years
Microsoft Word/1-3 Years
Microsoft Excel/1-3 Years
REQUIRED SKILLS
Leadership/Collaborating for Results
Leadership/Creating Accountability
Leadership/Driving a Culture of Compliance
DESIRED SKILLS
General Business/Managing Sales Relationships
Leadership/Fostering a Global Perspective
Service/Working Across Boundaries
ADDITIONAL JOB INFORMATION
This is an exciting and new opportunity to work with Mercy Maricopa Integrated Care, a non-profit organization administered by Aetna. Mercy Maricopa Integrated Care is looking for caring people who share our vision of recovery and integrated care. Mercy Maricopa Integrated Care is a great place to work. As an employee, not only will you be helping others, youll be part of a team just as dedicated as you. Our company values diversity and is dedicated to helping you achieve your career goals.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Business Support & Technical
POSITION SUMMARY
Process accurate and timely eligibility into Aetna Systems utilizing Aetna policy guidelines and in accordance with key performance measures and first claim/first call resolution. Provide Plan Sponsors with accurate bills and members with timely and accurate ID cards and audit cert lists. Improvement of financial results by reducing losses associated with non-payment. Ensures collected reconciled dollars are allocated across benefits and structure. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data.
Fundamental Components:
Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors.
Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.
Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.
Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information. Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity.
Utilizes and interprets on line resources to understand customers account structure and benefits. May assist with the development of such resources.
Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.
Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
Additional information:
Sound understanding of system errors and how to resolve efficiently.
Strong verbal and written communication skills.
BACKGROUND/EXPERIENCE
Additional Information (situational competencies, skills, work location requirements, etc.)
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Administration / Operations/Data Entry/1-3 Years
Functional - Customer Service/Customer service - production environment/1-3 Years
TECHNOLOGY EXPERIENCES
Microsoft Outlook/1-3 Years
Microsoft Word/1-3 Years
Microsoft Excel/1-3 Years
REQUIRED SKILLS
Leadership/Collaborating for Results
Leadership/Creating Accountability
Leadership/Driving a Culture of Compliance
DESIRED SKILLS
General Business/Managing Sales Relationships
Leadership/Fostering a Global Perspective
Service/Working Across Boundaries
ADDITIONAL JOB INFORMATION
This is an exciting and new opportunity to work with Mercy Maricopa Integrated Care, a non-profit organization administered by Aetna. Mercy Maricopa Integrated Care is looking for caring people who share our vision of recovery and integrated care. Mercy Maricopa Integrated Care is a great place to work. As an employee, not only will you be helping others, youll be part of a team just as dedicated as you. Our company values diversity and is dedicated to helping you achieve your career goals.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Business Support & Technical
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