Now hiring Enrollment Specialist II
The Enrollment Specialist II is responsible for maintaining current and accurate membership records by administering contractually defined eligibility and enrollment period guidelines and processing group and member transactions. In addition, the Enrollment Specialist II must be member focused in responding to questions or issues from health plan members and stakeholders regarding insurance benefits and coverage. Responsible for the administration of all federal and state regulatory requirements relative to enrollment and eligibility. Responsible for achieving prescribed department performance standards on a consistent basis.
How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community.
At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us: Full Time - Exempt: No Job is based Rev Hugh Cooper Admin Center Work hours: Days Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees. Benefits: PRN/PT (working less than a .45 FTE) employee benefits available for this position such as medical, free gym memberships and an employee wellness program. Preferred Qualifications: Albuquerque metro residents Only High school diploma (or G. E. D.) plus one to three years of experience in Enrollment/Eligibility. Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff. Written communication skills as well as business writing and presentation skills are required. Requires excellent organizational skills as well as a demonstrated ability to maintain professionalism and accuracy in high pressure situations. As a department subject matter expert and informal leader, the Enrollment Specialist II must demonstrate team work, ability to effectively perform peer coaching, and professionalism. Ability to use and teach efficiency tips on office support and department specific tools, available at the desktop (example: MS Outlook, Word, Excel, Email etc.) As an Enrollment Specialist II you will take on the role of Department Subject Matter Expert, responsible maintaining eligibility information for members as well as identifying knowledge gaps and efficiency opportunities including: Processing enrollment eligibility data for all product lines Understanding and administering eligibility/enrollment guidelines including waiting periods, continuation guidelines, maximum age policies, including the student certification process for specified groups. Generating all required member enrollment materials Coordinating the processing of member identification cards Reporting status of Service Level Agreements to Enrollment Leadership and providing a recommended path forward Acting as a Subject Matter Expert, Enrollment Specialist II will maintain 98% personal accuracy Performing peer quality audits and provide subject matter coaching and feedback aimed at improving department quality Troubleshooting and resolving member eligibility inquiries real time Identifying department gaps in knowledge Fielding and Resolving escalated and time sensitive issues Assisting with audit preparation and document gathering We're all about well-being, starting with yours. About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1200 providers and nearly 3,500 nurses.
Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments .
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
USD $21.48/Hr.
