Note: The job is a remote job and is open to candidates in USA. CVS Health is a healthcare company focused on simplifying health care and improving connected member experiences. The Eligibility Consultant supports insurance verification, enrollment and billing issue resolution, revenue cycle operations, compliance, and customer service while maintaining accurate eligibility information and supporting related products and processes.
Responsibilities
- Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns
- Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes
- Maintains enrollment databases and coordinates transfer of non-electronic eligibility data
- Monitors daily status reports assessing output for developing trends potentially impacting service levels.- Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters
- Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization
- Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports)
- Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.- When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging
- Interprets and translates client benefits and supporting account structure against internal systems/applications
- Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services
- Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients
Skills
- 1-3 years of data entry experience
- 1-3 years of Microsoft Suite experience
- 1-3 years of customer service experience
- Must reside and work in Arizona
- High school diploma or equivalent
- Familiar with Medicare and Medicaid coordination of benefits
- Prior experience with insurance providers
- Detail oriented and quality focused
- Phoenix based
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
Company Overview