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Company: Molina Healthcare
Location: San Antonio, TX
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech

Description


Strong ability to use MS Excel of reviewing created spreadsheets, sorting, finding, filtering, extracting data. Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via claims, call tracking, or e-mail. Maintain records in the enrollment database.

Knowledge/Skills/Abilities
• Defines, monitors and reports to management performance and productivity standards specific to those systems that must be in place to meet regulatory requirements, serve Molina's provider network and its enrolled population.
• Process,create and analyze eligibility lists and exports. Validates membership enrollment extracts for all vendors including ID card vendor processing.
• Performs processes to resolve the following eligibility exceptions within the required State/Regulatory timeframes: enrollment file errors, ID card generation errors, PCP assignments and 834 enrollment files to vendor/thrid party administrators.
• Provides daily support to the newborn enrollment functions, to include call center request for verification and updates, PCP assignment activity, enrollment record error reports, enrollment/disenrollment activity, COB verification, claims pended for enrollment or COB verification, member merge functions and Mass Member Moves including letter distribution
• Participate as a team player by demonstrating support to peers, management and the department's goals.Train new staff on departmental responsibilities.
Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials.
Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via claims, call tracking, or e-mail. Maintain records in the enrollment database.

Qualifications

Job Qualifications

Required Education
Associate's Degree or equivalent combination of education and experience
Required Experience
3-5 years
Required Li
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
5-7 years
Preferred Li

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.


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