Cencal Health
Job Details
Job Location Main Office - Santa Barbara, CA
Position Type Full Time
Salary Range $23.30 - $32.62 Hourly
Job Category Member Services
Description
Central Coast Hourly Range - $23.30 - $32.62
Candidates for this position must reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties) or be willing to relocate to the area upon hire. As a community-facing role, a local presence is essential to effectively engage with and serve our community. Please note that relocation assistance may be available.
Job Summary
Expectations of this position are to provide support to the Lead Eligibility Representative department staff for all eligibility / membership functions relating to enrollment, disenrollment, and reconciliation processes for all CenCal Health Programs. This position provides primary eligibility queue support and service for the Plan's provider network, community-based organizations, and government agencies such as DSS, SSA, TCRC, CCS/CHDP, and County Foster Children. The Eligibility Representative is proficient in member eligibility and supports the Member Services Department.
Duties and Responsibilities
This position is the primary contact in the Eligibility Queue for the Plan's Physician/Provider network, CBOs, and government agencies as noted above which includes responding to correspondence requesting eligibility verification and must maintain the established metrics that include 5.50 hours of coverage in the Eligibility queue.
Processing 100% of site-to-site PCP change selections received via fax, and mail. Work the Monthly Eligibility Reports to completion between incoming call volume each month, and ensure they are submitted by their respective due dates. Log billing issue receipts with appropriate file preparation for Billing Coordinators. Backs up the Eligibility Unit Clerk as needed. Provides support to the Lead Eligibility Representative/Associate Director. Sets up and distribute the provider recap report for all programs. Works the End of Month (EOM) process each month in a timely, and accurate manner. Perform other duties or special projects as assigned by the Member Services Operations Manager and Associate or Department Director. Other duties as assigned. Qualifications
Knowledge / Skills / Abilities
Must have the ability to multi-task; demonstrate good judgment in making decisions within the scope of the position; ability to work independently with minimal supervision; good oral and written communication skills. Demonstrate a complete knowledge of the Plan HIS- Caradigm System screens noted below relating to member eligibility data while meeting established departmental service standards for accuracy, timeliness (ASA & Abandon Rate) of call answers within 1 ring and 3.5 hours daily in the eligibility queue to meet departmental standards. Must have the ability to multi-task; demonstrate good judgment in making decisions within the scope of the position; ability to work independently with minimal supervision; good oral and written communication skills. Necessary Screens
Eligibility and sub-screens
CalWIN & CalSAWS
Provider Screen
HIS-Call Tracking System
Education and Experience
AA Degree or a minimum of (3) three years equivalent experience in a customer service environment (preferably in health care or managed care). Knowledge of the Medi-Cal and Social Security programs.
Job Location Main Office - Santa Barbara, CA
Position Type Full Time
Salary Range $23.30 - $32.62 Hourly
Job Category Member Services
Description
Central Coast Hourly Range - $23.30 - $32.62
Candidates for this position must reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties) or be willing to relocate to the area upon hire. As a community-facing role, a local presence is essential to effectively engage with and serve our community. Please note that relocation assistance may be available.
Job Summary
Expectations of this position are to provide support to the Lead Eligibility Representative department staff for all eligibility / membership functions relating to enrollment, disenrollment, and reconciliation processes for all CenCal Health Programs. This position provides primary eligibility queue support and service for the Plan's provider network, community-based organizations, and government agencies such as DSS, SSA, TCRC, CCS/CHDP, and County Foster Children. The Eligibility Representative is proficient in member eligibility and supports the Member Services Department.
Duties and Responsibilities
This position is the primary contact in the Eligibility Queue for the Plan's Physician/Provider network, CBOs, and government agencies as noted above which includes responding to correspondence requesting eligibility verification and must maintain the established metrics that include 5.50 hours of coverage in the Eligibility queue.
Processing 100% of site-to-site PCP change selections received via fax, and mail. Work the Monthly Eligibility Reports to completion between incoming call volume each month, and ensure they are submitted by their respective due dates. Log billing issue receipts with appropriate file preparation for Billing Coordinators. Backs up the Eligibility Unit Clerk as needed. Provides support to the Lead Eligibility Representative/Associate Director. Sets up and distribute the provider recap report for all programs. Works the End of Month (EOM) process each month in a timely, and accurate manner. Perform other duties or special projects as assigned by the Member Services Operations Manager and Associate or Department Director. Other duties as assigned. Qualifications
Knowledge / Skills / Abilities
Must have the ability to multi-task; demonstrate good judgment in making decisions within the scope of the position; ability to work independently with minimal supervision; good oral and written communication skills. Demonstrate a complete knowledge of the Plan HIS- Caradigm System screens noted below relating to member eligibility data while meeting established departmental service standards for accuracy, timeliness (ASA & Abandon Rate) of call answers within 1 ring and 3.5 hours daily in the eligibility queue to meet departmental standards. Must have the ability to multi-task; demonstrate good judgment in making decisions within the scope of the position; ability to work independently with minimal supervision; good oral and written communication skills. Necessary Screens
Eligibility and sub-screens
CalWIN & CalSAWS
Provider Screen
HIS-Call Tracking System
Education and Experience
AA Degree or a minimum of (3) three years equivalent experience in a customer service environment (preferably in health care or managed care). Knowledge of the Medi-Cal and Social Security programs.