SCAN
About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The job
To maintain the SCAN Health Plan core eligibility system by reconciling, entering, correcting, and deleting member information in compliance with Medicare Centers of Medicare Services (CMS) and Medi-Cal Department of Health Care Services (DHCS) regulations. Support business units external, and internal to the Enrollment, Reconciliation and Premium Billing Department with reconciliation and production processing efforts by completing regular and ad hoc projects involving reconciliation and business process.
Enrollment Operational Specialist will ensure timely research and resolution for enrollment errors and discrepancies to assure accuracy and downstream operational efficiency.
You Will Process member enrollment applications by reviewing electronic, telephonic, and paper enrollment data received for deficiencies, establishing data entry priorities to ensure timely processing and resolving discrepancies by using departmental policies and procedures. Enters member data by inputting alphabetic and numeric information into ika system according to screen format including benefit assignment, group affiliation, and provider selection, billing information, revenue codes and appropriate cross references. Handles highly confidential and Protected Health Information (PHI) and Payment Card Information (PCI) such as Medicare Beneficiary Number, Social Security Number, Medicaid Number and Financial Data and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times. Research and Resolve identified discrepancies, written complaints and complex or multi-issue provider complaints submitted and prepare eligibility related findings to Analyst Team and/or management. Analyzes data from several sources to determine eligibility changes, updates and resolve enrollment or eligibility errors. Reconciles transactions, creates, and processes corrections and disputes to maintain accurate records. Coordinates the resolution of cases received thorough MedHOK including but not limited to member grievances, appeals and eligibility updates by researching all enrollment and/or eligibility requests received, providing a written response, updating members plan and or eligibility. Identifying root causes and reporting any findings to Management and internal business areas implications and decisions and identifies process improvements to address areas of identified non-compliance. Rotate through Reconciliation and Operations tasks as needed and as directed by Enrollment Supervisor Work with cross-functional departments by providing support to Enrollment, Reconciliation and Premium Billing; with an emphasis on front-line problem solving. Provides excellent customer services by making a high volume of outbound calls for prospective, existing members and/or providers to gather, clarify, obtain, pertinent information and or confirm information needed to successfully complete enrollment election requests, grievances, and appeals. Receiving internal and external incoming calls received. The ability to accurately understand enrollment eligibility, benefits, CMS and DHS regulations and requirements in person, via email or telephonically. Address and complete requests received through MedHOK, MC400, IkaSystems, Department Inbox, Department Queue, and through telephone from Member Services, Sales and other internal and external customers including but not limited to member quality or access to care, benefits or eligibility issues by responding appropriately and in a timely fashion by answering telephonic and written inquiries; following department policies and procedures, and by professionally representing the department to others Complete timely and accurate documentation in multiple computer systems to meet regulatory requirements. Prepares member correspondence by creating, triggering, printing, reviewing, and mailing. Maintains professional and technical knowledge by utilizing access to SCAN University on-line trainings, attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Actively support the achievement of SCAN's Mission, Vision, and Goals. Ensures regulatory compliance by following departmental desktops, policies, and procedures, by adhering to state and federal regulations and requirements. Your qualifications
High school diploma or general education degree; AA or work equivalent preferred. 2-3 years of Eligibility & Reconciliation experience, preferably within a health plan or healthcare company. Working knowledge of local, state and federal guidelines / regulations (CMS, DMHC, DHCS) preferred. Experience working with ika systems, MC400 and/or other healthcare systems required. PC SKILLS
:
PC Skills, Email, Word, Excel, PowerPoint and Access preferred SKILLS/ABILITIES
:
Excellent communication skills both oral and written preferred 1+ year Call Center experience Ability to prioritize multiple and competing tasks, work independently, remotely and in a team environment Excellent communication, organizational, and interpersonal skills; Ability to multitask Strong analytical and critical thinking skills, required Ability to appropriately maintain confidentiality Ability to work well under pressure and within deadlines required Ability to work independently and in a team environment. Bi-lingual (English/Spanish) preferred
What's in it for you?
Base Salary range: $20.00 - $30.38 per hour
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 additional floating holiday
Excellent 401(k) Retirement Saving Plan with employer match.
Robust employee recognition program
Tuition reimbursement
A work-life balance
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
#LI-DNI
#SCANONLY
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The job
To maintain the SCAN Health Plan core eligibility system by reconciling, entering, correcting, and deleting member information in compliance with Medicare Centers of Medicare Services (CMS) and Medi-Cal Department of Health Care Services (DHCS) regulations. Support business units external, and internal to the Enrollment, Reconciliation and Premium Billing Department with reconciliation and production processing efforts by completing regular and ad hoc projects involving reconciliation and business process.
Enrollment Operational Specialist will ensure timely research and resolution for enrollment errors and discrepancies to assure accuracy and downstream operational efficiency.
You Will Process member enrollment applications by reviewing electronic, telephonic, and paper enrollment data received for deficiencies, establishing data entry priorities to ensure timely processing and resolving discrepancies by using departmental policies and procedures. Enters member data by inputting alphabetic and numeric information into ika system according to screen format including benefit assignment, group affiliation, and provider selection, billing information, revenue codes and appropriate cross references. Handles highly confidential and Protected Health Information (PHI) and Payment Card Information (PCI) such as Medicare Beneficiary Number, Social Security Number, Medicaid Number and Financial Data and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times. Research and Resolve identified discrepancies, written complaints and complex or multi-issue provider complaints submitted and prepare eligibility related findings to Analyst Team and/or management. Analyzes data from several sources to determine eligibility changes, updates and resolve enrollment or eligibility errors. Reconciles transactions, creates, and processes corrections and disputes to maintain accurate records. Coordinates the resolution of cases received thorough MedHOK including but not limited to member grievances, appeals and eligibility updates by researching all enrollment and/or eligibility requests received, providing a written response, updating members plan and or eligibility. Identifying root causes and reporting any findings to Management and internal business areas implications and decisions and identifies process improvements to address areas of identified non-compliance. Rotate through Reconciliation and Operations tasks as needed and as directed by Enrollment Supervisor Work with cross-functional departments by providing support to Enrollment, Reconciliation and Premium Billing; with an emphasis on front-line problem solving. Provides excellent customer services by making a high volume of outbound calls for prospective, existing members and/or providers to gather, clarify, obtain, pertinent information and or confirm information needed to successfully complete enrollment election requests, grievances, and appeals. Receiving internal and external incoming calls received. The ability to accurately understand enrollment eligibility, benefits, CMS and DHS regulations and requirements in person, via email or telephonically. Address and complete requests received through MedHOK, MC400, IkaSystems, Department Inbox, Department Queue, and through telephone from Member Services, Sales and other internal and external customers including but not limited to member quality or access to care, benefits or eligibility issues by responding appropriately and in a timely fashion by answering telephonic and written inquiries; following department policies and procedures, and by professionally representing the department to others Complete timely and accurate documentation in multiple computer systems to meet regulatory requirements. Prepares member correspondence by creating, triggering, printing, reviewing, and mailing. Maintains professional and technical knowledge by utilizing access to SCAN University on-line trainings, attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Actively support the achievement of SCAN's Mission, Vision, and Goals. Ensures regulatory compliance by following departmental desktops, policies, and procedures, by adhering to state and federal regulations and requirements. Your qualifications
High school diploma or general education degree; AA or work equivalent preferred. 2-3 years of Eligibility & Reconciliation experience, preferably within a health plan or healthcare company. Working knowledge of local, state and federal guidelines / regulations (CMS, DMHC, DHCS) preferred. Experience working with ika systems, MC400 and/or other healthcare systems required. PC SKILLS
:
PC Skills, Email, Word, Excel, PowerPoint and Access preferred SKILLS/ABILITIES
:
Excellent communication skills both oral and written preferred 1+ year Call Center experience Ability to prioritize multiple and competing tasks, work independently, remotely and in a team environment Excellent communication, organizational, and interpersonal skills; Ability to multitask Strong analytical and critical thinking skills, required Ability to appropriately maintain confidentiality Ability to work well under pressure and within deadlines required Ability to work independently and in a team environment. Bi-lingual (English/Spanish) preferred
What's in it for you?
Base Salary range: $20.00 - $30.38 per hour
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 additional floating holiday
Excellent 401(k) Retirement Saving Plan with employer match.
Robust employee recognition program
Tuition reimbursement
A work-life balance
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
#LI-DNI
#SCANONLY
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.