Healthcare Medicare Eligibility Representatives
Job Title: Eligibility Associate Representatives Pay Rate: $16/Hour... 100% work at home Start Date: 10/14/2024-End Date: 3/31/2025 (Higher possibility of an extension) 8:30am 5:00pm EST (prefers candidates who live in EST & CST) Quick notes/highlights: Familiarity of/ having a basic knowledge of Medicare will be helpful for these candidates. Customer service experience that has exposure to insurance or Medicare will be helpful. They will be trained in a few parts of the team and deployed as needed to support different branches of the team Need to have basic computer skills. These candidates need to know how to navigate different screens and programs. Need to have basic Microsoft Office/Excel skills and experience High volume work. When they log-in, they will be assigned a queue of what they need to work on They will receive Q-Net and Medicare training, will learn how to process the records they receive in their queues Some candidates might have to be on the phone more than others depending on the team they are placed on. Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle reconciliation for non-standard requests. May provide technical support for the electronic procession of eligibility. Ensures customer data is installed accurately and timely. Technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision, but have ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. ESSENTIAL FUNCTIONS Facilitates accurate processing of Enrolment applications to ensure timely input and acceptance to CMS. Performs account benefit verification requiring complex decision skills based on payer and process knowledge resulting in proper access to care. Process Reconciliation files from CMS to include Disenrollments, Late Enrollment Penalties and Low Income Subsidies Timely and Accurate processing of monthly Premium payments including identification and processing of write offs, resolution of credit balances and posting of payments to member accounts Process Coordination of Benefits and Medicare Secondary Payer files from CMS to meet Federal and State Regulatory guidelines. Ensure accuracy of data entry to allow for meeting proper Service Level Agreements Use discretion & independent judgement in handling more complex cases and be willing to learn new skills within the Enrollment Functions Directly interfaces with other teams within Cigna Provide support to other internal functions as needed. May need to be proficient in Multiple Systems Completes other projects and additional duties as assigned. Skills Knowledge of CMS Enrolment & Reconciliation process Knowledge of CMS Billing requirements and regulations Knowledge in Coordination of Benefits and Medicare Secondary Payer Medicare Part C and Part D Health care experience with medical insurance knowledge and terminology and experience in patient access preferred. Intermediate data entry skills and working knowledge of Microsoft Office. Excellent presentation and communication skills. Demonstrated ability to handle challenging interactions in a professional manner. Ability to adapt in a dynamic work environment and make decisions with minimal supervision. Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions SQL (a plus not required) Education High school diploma or GED required; bachelors degree preferred. 3+ years of relevant working experience Apply Job!