Top 45 Enrollment and eligibility representative Jobs in Riverside, Ca

Eligibility Specialist II
WESTERN GROWERS ASSURANCE TRUST —Irvine, CA
- $40,580.28 - $52,756.02 a year
- Overtime
- Remote
- Spanish
- Microsoft Excel
- Microsoft Outlook
Quick Apply
15h
Admissions Specialist
University of California, Riverside —Riverside, CA
- $64,050 - $112,140 a year
- Weekends as needed
- Background check
- Mid-level
- University
ADMISSIONS REPRESENTATIVE
Spartan Education —Riverside, CA
- $28.85 - $41.82 an hour
- Weekends as needed
- Spanish
- Writing skills
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Enrollment Specialist
Central Neighborhood Hlth Fdn —San Bernardino, CA
- $25 an hour
- Full-time
- Spanish
- CPR Certification
- Medical office experience
- Health insurance
Quick Apply
Customer Service Representative I
WESTERN GROWERS ASSURANCE TRUST —Irvine, CA
- $35,288.33 - $45,874.31 a year
- Full-time
- Remote
- Spanish
- Writing skills
- Data analysis skills
Quick Apply
5d
Sr. Leave of Absence Specialist
University of California, Riverside —Riverside, CA
- $68,500 - $121,900 a year
- Full-time
- Background check
- HIPAA
- Windows
Patient Service Representative
Community Health Systems, Inc. —Moreno Valley, CA
- $23.00 - $29.39 an hour
- Full-time
- Spanish
- Writing skills
- Basic math
20h
College Admissions Advisor
Spartan College of Aeronautics and Technology —Riverside, CA
- $28.85 - $41.82 an hour
- Weekends as needed
- Spanish
- Mid-level
- Office
Quick Apply
7d
CCSB Eligibility Specialist I
PINNACLE CLAIMS MANAGEMENT INC —Irvine, CA
- $35,288.33 - $45,874.31 a year
- Full-time
- Remote
- Microsoft Word
- Spanish
- Microsoft Outlook
Quick Apply
Temp - Mobile Unit Patient Service Representative
Community Health Systems, Inc. —Riverside, CA
- $23.00 - $26.81 an hour
- Full-time
- Spanish
- Writing skills
- Basic math
Group Set-Up Specialist
WESTERN GROWERS GROUP —Irvine, CA
- $53,667.86 - $69,768.32 a year
- Full-time
- Remote
- HIPAA
- Research
- Mid-level
Quick Apply
Enrollment - Care Coordinator Specialist
Unicare Community Health Center —San Bernardino, CA
- $25 - $30 an hour
- Weekends as needed
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Flexible schedule
Nurse Practitioner/ Physician Assistant
Rancho Health MSO, Inc —Moreno Valley, CA
- $100,000 - $140,000 a year
- Full-time
- Private practice
- Spanish
- BC/BE
- Disability insurance
- Flexible schedule
Quick Apply
Wireless Enrollment Representative
Mallard Marketing —Riverside, CA
- $1,100 - $1,400 a week
- Full-time
- Background check
- No experience needed
- High school diploma or GED
- 401(k)
- Employee discount
Quick Apply
1d
Community Relations Representative
Efficient California —Grand Terrace, CA
- $950 - $1,550 a week
- Full-time
- Mid-level
- Presentation skills
- In-person
- 401(k)
Quick Apply
20h
Customer Service Representative (Temp) - Reception
East Valley Community Health Center —Pomona, CA
- $22.00 - $24.80 an hour
- Temporary
- Spanish
- Computer literacy
- English
- Paid holidays
- Health insurance
Quick Apply
22h
Backlog Referral Coordinator
Central Neighborhood Hlth Fdn —San Bernardino, CA
- $25 an hour
- Full-time
- Spanish
- CPR Certification
- Word processing
Quick Apply
Family Case Specialist
MEXICAN AMERICAN OPPORTUNITY FOUNDATION —Ontario, CA
- $24.99 - $26.32 an hour
- Weekends as needed
- Spanish
- Computer literacy
- Writing skills
- Paid jury duty
- 403(b) matching
Assistant Director, Campus Tours & Events (Administrator I), Outreach and Student Recruitment
California State University —San Bernardino, CA
- Weekends as needed
- Background check
- Spanish
- Master's degree
- Paid holidays
- Health insurance
EHS FAMILY SERVICE ADVOCATE
Volunteers of America Southwest —San Bernardino, CA
- $23 - $29 an hour
- Weekends as needed
- Spanish
- English
- Windows

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Eligibility Specialist II

WESTERN GROWERS ASSURANCE TRUST -
Irvine, CA

Quick Apply

Job Details

Full-time
$40,580.28 - $52,756.02 a year
15 hours ago

Qualifications

Optimizing workflow processes
X12 EDI
Spanish
Insurance products customer support
Microsoft Excel
Financial data reconciliation
Email customer support
Microsoft Outlook
EDI
Account maintenance
Cash application
Phone communication
Standard Operating Procedures (SOPs) implementation
5 years
Account troubleshooting
Health insurance policy knowledge
Health insurance customer support
HIPAA
Performance feedback (performance evaluation method)
Mid-level
Refund processing
Employee Retirement Income Security Act of 1974 (ERISA)
Financial issue resolution
High school diploma or GED
Analysis skills
Policy & process development
Team training
Quality improvement
Vendor communication
Health information regulatory compliance

Full Job Description

JOB DESCRIPTION SUMMARY

This position reports to the Supervisor I, Enrollment and Eligibility. The Eligibility Specialist II requires the ability to process enrollment and billing functions, both automated and manual, with in the company’s processing system necessary to maintain Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc. (PCMI) accounts) as assigned including groups that submit Electronic Data Interchange (EDI) eligibility. This role will provide customer service support to clients by instructing them on correct eligibility management and explaining billing and payment issues. They will also research and resolve eligibility and billing discrepancies or client inquiries.

DUTIES AND RESPONSIBILITIES

Department Operations

Process all transaction types such as adds, terms, changes, carrier discrepancies and other eligibility related tasks for all lines of business, WGAT, and Pinnacle.
Review and process all manual and/or EDI enrollment transactions (adds, changes, terminations) in HCPS as received from the client or internal sources in accordance with Participation Agreements, Employer Policy Statements, Eligibility Guidelines, and Summary Plan Descriptions.
Research and correct cash application issues in company’s processing system. Determine and correct out of balance ledger items on accounts. Contact clients to explain and resolve billing and payment discrepancies. Verify or authorize refunds for terminations and overpayments.
Perform full reconciliations on accounts in order to confirm that the group is in compliance.
Maintain a HIPAA compliant workstation and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client and enrollee data.
Meet processing cycle time standards and production due dates as set forth by management.
Maintain performance in accordance with established quality standards, as measured by audit metrics. Consistently meet or exceed audit score requirements to ensure accuracy, compliance, and service excellence.
Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
Create and document Standard Operating Procedures (SOP’s).
Identify, initiate, and implement process improvements and/or innovation.

Customer Service

Work with clients to facilitate payments on time and for the billed amount.
Provide timely and effective Customer Service to clients for requests, inquiries, or issues concerning enrollment and/or billing items on their account via phone calls by logging into Genesys and taking calls based on daily phone schedule.
Interface effectively with internal departments and external vendors, brokers, or other business contacts to coordinate interrelated activities and to resolve eligibility and/or billing issues as they arise.
Serve as a representative of Wester Growers and PCMI displaying professionalism, knowledge, customer service, and discretion in all interactions with other members of the Western Growers/PCMI community and their customers.

Team Development

Provide guidance, feedback, and support to new team members with processing and listening to their phone calls.
Identify training deficiencies and provide feedback to administration leads.
Provide backup as subject matter expert for new employees.
Demonstrate support and collaboration within the team by offering assistance and providing resources when possible.

Other

Maintain integrity and transparency in all tasks, ensuring alignment with team and organizational goals.
Hold oneself accountable by taking ownership of actions, decisions, and their outcomes.
Reflect on personal performance regularly, identifying areas for improvement and celebrating successes.
Commit to continuous learning and growth, seeking feedback and implementing constructive changes.
Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.

Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA- required protection of all confidential/protected client data.
Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
All other duties as assigned.

PHYSICAL DEMANDS/WORKENVIRONMENT

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

QUALIFICATIONS

High School diploma or equivalent and three (3) to five (5) years of accounting/business experience with knowledge of generally accepted accounting procedures, analytical abilities, or equivalent combination of education and experience preferred.
Intermediate knowledge of generally accepted health care eligibility and billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), California Continuation Benefits Replacement Act (Cal-COBRA) and Employee Retirement Income Security Act (ERISA) legislation.
Strong experience with Microsoft Office products such as Word, Outlook, PowerPoint, and Excel.
Strong ability to develop proficiency working with a proprietary health care system.
Knowledge of processing Electronic Data Interchange (EDI) file updates in a legacy system.
Experience providing customer service to a variety of client contacts via email and telephone.
Demonstrated ability to research and resolve technical issues and client problems as they arise with minimal direction.
Excellent written and oral communication skills including modern business communications, formatting of professional letters, reports, and phone etiquette.
Demonstrated time management skills including, multi-tasking, working under pressure and deadlines, and working independently with minimal supervision or in team environment.
Strong knowledge of health insurance operations and industry.
Bilingual Spanish, both verbal and written a plus.
Ability to work overtime as needed.
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
Home router with wired Ethernet (wireless connections and hotspots are not permitted).
A designated room for your office or steps taken to protect company information
A functioning smoke detector, fire extinguisher, and first aid kit on site.

Quick Apply

Refine Your Search

enrollment and eligibility representative jobs in riverside, ca

Eligibility Specialist II

Admissions Specialist

ADMISSIONS REPRESENTATIVE

Enrollment Specialist

Customer Service Representative I

Sr. Leave of Absence Specialist

Patient Service Representative

College Admissions Advisor

CCSB Eligibility Specialist I

Temp - Mobile Unit Patient Service Representative

Group Set-Up Specialist

Enrollment - Care Coordinator Specialist

Nurse Practitioner/ Physician Assistant

Wireless Enrollment Representative

Community Relations Representative

Customer Service Representative (Temp) - Reception

Backlog Referral Coordinator

Family Case Specialist

Assistant Director, Campus Tours & Events (Administrator I), Outreach and Student Recruitment

EHS FAMILY SERVICE ADVOCATE

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