esponsible for ensuring the monthly workflow within the eligibility department complies with turnaround times, deadlines and quality standards are met or exceeded through audits of all processes. Complete the process of eligibility updates and changes according to client plan documents and the Home Plan’s monthly eligibility downloads and all clerical functions within the eligibility department.
What You’ll Be Doing
- Prioritize the monthly Eligibility process based on capitation and claims processing.
- Input and maintain returned eligibility forms and documents daily.
- Generate member notification letters.
- Track website inquiries and urgent additions from other departments.
- Responsible to work eligibility appeals forwarded by other departments.
- Responsible to work on a monthly, daily and weekly audit reports.
- Contact Home Plan for clarification of eligibility.
- Build and maintain group files, coordinate benefit plan updates and additions with the Auditing and System Compliance Operations team.
- Assist with maintaining the PCP auto assignment process through Access reporting based on geographical areas and updating the member’s eligibility file.
- Assist with downloading on a weekly basis the OPX files from the Home plan and flag the member’s eligibility files as indicated, communications to the claims department regarding the OPX status.
- Assist Senior Eligibility Compliance Coordinator or Eligibility Compliance Lead with maintaining members with the exchange product that are under the APTC status and their grace periods.
- Stay current on federal and state eligibility requirements.
- Work with Eligibility Compliance Lead on automating processes and building new reporting.
- Other duties and responsibilities as assigned.
WHAT SUCCESS LOOKS LIKE
- In 3 months
- Perform OPX related tasks with minimal supervision.
- Achieve and maintain a quality score of 93% or better.
- Complete an average of 80 or more record adds daily.
- In 6 months
- Assist in writing and maintaining department workflow documents and training materials.
- Assist with APTC status and grace period updates.
- Achieve and maintain a quality score of 94% or better.
- Complete an average of 100 record adds daily.
- In 12 months
- Function independently with minimal guidance.
- Bring forward new ideas and processes.
- Maintain quality score of 97% or better.
- Complete an average of 120 record adds daily.
WHAT YOU’LL NEED TO HAVE
- Minimum 2-3 years of experience in the healthcare or managed care industry, primarily in the eligibility role with an understanding of Coordination of Benefits rules.
- Advanced proficiency in the Microsoft Office products, especially Microsoft Word, MicrosoftExcel, Microsoft Outlook, & Microsoft Access.
- Successfully function as an Eligibility Specialist.
- Ability to work independently with minimal supervision and as part of a team.
- Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data.
- Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player.
- Demonstrates the ability to multi-task with minimal supervision and the ability to prioritize appropriately
- Able to problem solve, exercise initiative and make low to medium level decisions
- Basic understanding of current federal, state and local healthcare compliance requirements.
- Effective written and oral communication.
What You’ll Get
- Learn the life of a Contract Management firm with Independent Physician Associations across Illinois.
- Encouragement to bring ideas to the table.
- Be part of a desired team within Arcadia’s Value Based Services.
- Opportunity to be part of a team creating automated processes to drastically improve healthcare.
- Extraordinary and flexible work environment and culture.
- Competitive compensation.
- Amazing benefits package including flexible time off.
- Receive cash compensation with health, dental, and other benefits
- A flexible, remote friendly company with personality and heart
- Employee driven programs and initiatives for personal and professional development
- Be a member of the Arcadian and Barkadian Community
WOULD LOVE FOR YOU TO HAVE
- Experience and knowledge with Managed Care Eligibility, Medicare, and Coordination of Benefits strongly encouraged.
WHAT YOU GET
- Learn the life of a Contract Management firm with Independent Physician Associations across Illinois.
- Encouragement to bring ideas to the table.
- Be part of a desired team within Arcadia’s Value Based Services.
- Opportunity to be part of a team creating automated processes to drastically improve healthcare.
- Extraordinary and flexible work environment and culture.
- Competitive compensation.
- Amazing benefits package including flexible time off.
- Receive cash compensation with health, dental, and other benefits
About Arcadia
Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website, our online resources, and our interactive Data Gallery.
This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia’s custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.