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6201 San Ignacio Avenue
San Jose, CA 95119
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Enrollment Coordinator I
Santa Clara Family Health Plan • San Jose, CA
Posted 2 months ago
Consider a career at Santa Clara Family Health Plan (SCFHP), a public, not-for-profit plan of over 250,000 members serving Santa Clara County.
GENERAL DESCRIPTION OF POSITION
The Enrollment Coordinator I provides timely data entry, tracking, validation, monitoring, reporting and supporting communications to maintain accurate enrollment, eligibility and premium data for one or more lines of business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and SCFHP business requirements, to achieve Department performance objectives.
ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.
- Process all program applications (new and renewal), disenrollment requests and premium payment transactions within required timeframes; includes providing members with application assistance and processing all associated correspondence.
- In response to internal and external inquiries and in support of initiatives, work collaboratively with others to analyze, verify and resolve enrollment, eligibility and premium billing issues in an accurate, timely, respectful, professional and culturally competent manner; communication may be via inbound call, outbound call, in-person, fax, email, mail, or other appropriate communication channel.
- Accurately document and code all contacts and follow-up actions for member, provider and other communications and activities in accordance with established guidelines.
- Track, analyze, validate and process assigned daily, weekly, and monthly enrollment and membership eligibility, A/R, integrity, audit, reconciliation/validation, and error reports accurately and in a timely manner.
- Identify, investigate, troubleshoot, and report eligibility and enrollment issues, errors and/or discrepancies.
- Provide input to required internal and external reporting, including dashboards.
- Ensure process for delivering member materials to new and existing members is completed accurately and within the required timeframe.
- Use operating instructions and tools needed to support department activities and to ensure compliance with all regulations.
- Provide direct support for new member enrollment and for member retention via inbound and/or outbound calling.
- Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
- Identify issues and report relevant information to management.
- Provide support for implementation/upgrade/improvements of internal systems that support department processes; includes but is not limited to providing input to requirements and reporting results and potential defects.
- Perform other related duties as required or assigned.
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
1. High School Diploma or GED.
2. Minimum one year of experience in a health plan in jobs requiring interaction with members.
3. Able to efficiently alternate focus between telephone and non-telephone tasks to support Department operations as dictated by business needs.
4. Work weekends and company holidays as needed based on business and regulatory requirements.
5. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel.
6. Ability to use a keyboard with moderate speed and a high level of accuracy.
7. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP members and providers over the telephone, in person or in writing.
8. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes.
9. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position.
10. Ability to maintain confidentiality.
11. Ability to comply with all SCFHP policies and procedures.
12. Ability to perform the job safely with respect to others, to property, and to individual safety.
1. Prior experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations.
2. Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills.
Santa Clara Family Health Plans offers a comprehensive benefits package including PTO, holidays, fitness center membership, medical, dental, and vision coverage, CalPERS retirement, 401a and 457 Deferred Compensation retirement plans.
To view the full job description or to apply please visit our careers page at www.scfhp.com.