ACA Enrollment Specialist
Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Responsibilities:
Under the general supervision of the ACA Exchange Operations Manager, responsible for all investigation and reconciliation associated with all member data on a daily basis to ensure all members have access to care. Acts as a Subject Matter Expert for the department. ; Resolves and provides direction to peers. ;Participates in project implementations. Completes special projects and reconciliation(s) in collaboration with various departments. ;Knowledgeable of all Enrollment and Eligibility Reports. Keeps current on rules, regulations, policies, and procedures, relating to the various ACA Enrollment guidelines and requirements. Provides customer service for internal and external clients.
Ensures the timely and accurate processing of individual enrollment eligibility changes. Reviews member demographic information against the eligibility portal and updates the Facets system as required. ;Assignments and updates include; new enrollments, dis-enrollments, re-enrollments, category changes, demographic changes, PCP updates. Accurately reconcile daily/weekly/monthly reports. ;Follows internal processes and procedures to ensure activities are handled timely and in accordance with contractual and departmental policies.
Acts as an Enrollment Subject Matter Expert (SME). Responsible for participating in User Acceptance Testing for Company Upgrades, Projects and new business implementations as it relates to Enrollment and Eligibility functionality.
Knowledgeable of all Enrollment and Eligibility Report processes. Assists new hires, transfer associates and existing enrollment specialists on desktop and systems procedures.
Provides notification of pregnancy, newborn, and address, changes to appropriate providers, state agencies, brokers, and clients as indicated in the business requirement.
Assists external and internal customers by responding to and resolving inquiries received via Outlook and Macess EXP related to member enrollment processes.
Uses multiple systems that include Uses Facets, EXP, Staging Tables, and Vendor systems to investigate and analyze member eligibility issues and data discrepancies. ;Trouble shoot, solve exceptions, and unusual situations.
Track and monitor incoming responses to inquiries on a daily basis. ;May provide tracking information to internal departments to facilitate information gathering for staffing purposes.
Demonstrates ability to identify trends and distinguish between routine and significant matters; identifies exceptions and provides written documentation to support decision as required.
Apprises management and IT of issues, which can positively/negatively affect services.
Reconciles audit discrepancies, corrects in the Facets system and make appropriate changes to avoid recurrence.
Maintains thorough knowledge of enrollment process systems Maintains thorough knowledge of enrollment process systems, its databases and subsystems.
Assists department and company in managing member/group enrollment inventories by meeting deadlines on a daily basis.
Handles internal requests from internal and external departments to investigate and update member enrollment information.
Meets required production and quality standards.
Consistently adheres to all established departmental and company deadlines. Participates in departmental self-audits procedures for on-going evaluation of services to ensure monthly departmental standard and met.
Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with ACFC employees and clients at all times. ;Adheres to ACFC policies and procedures; supports and carries out the company Mission and Values. ;Demonstrates and supports commitment to corporate goals and mission.
Supports the HICS Analyst(s) with eligibility research, case resolution and member reconciliation on an ongoing basis. Completes eligibility updates as required and provides a detailed accounting of all actions taken to resolve cases.
Researches returned checks and submit service requests through the vendor system to have check issues resolved.
Reviews and resolves pre and post Facets vendor discrepancies daily and ensures that all vendor discrepancies are addressed in a timely manner.
Interacts with other departments and key vendors to resolve issues.
Maintains an awareness of Affordable Care Act regulations with regard to enrollment, billing, grace periods, special enrollment periods, and open enrollment.
Performs other related duties and projects as assigned.
Education/Experience:
Associates Degree preferred.
3-5 years prior enrollment experience required.
3-5 years prior experience researching and analyzing data required.
3-5 years prior HealthCare/Managed care experience required.
Intermediate Microsoft Office Skills including Word, Excel, and Access.
Data mining and root cause analysis skills.
Excellent verbal and written skills.
Diversity, Equity, and Inclusion
At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
Apply Now
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Responsibilities:
Under the general supervision of the ACA Exchange Operations Manager, responsible for all investigation and reconciliation associated with all member data on a daily basis to ensure all members have access to care. Acts as a Subject Matter Expert for the department. ; Resolves and provides direction to peers. ;Participates in project implementations. Completes special projects and reconciliation(s) in collaboration with various departments. ;Knowledgeable of all Enrollment and Eligibility Reports. Keeps current on rules, regulations, policies, and procedures, relating to the various ACA Enrollment guidelines and requirements. Provides customer service for internal and external clients.
Ensures the timely and accurate processing of individual enrollment eligibility changes. Reviews member demographic information against the eligibility portal and updates the Facets system as required. ;Assignments and updates include; new enrollments, dis-enrollments, re-enrollments, category changes, demographic changes, PCP updates. Accurately reconcile daily/weekly/monthly reports. ;Follows internal processes and procedures to ensure activities are handled timely and in accordance with contractual and departmental policies.
Acts as an Enrollment Subject Matter Expert (SME). Responsible for participating in User Acceptance Testing for Company Upgrades, Projects and new business implementations as it relates to Enrollment and Eligibility functionality.
Knowledgeable of all Enrollment and Eligibility Report processes. Assists new hires, transfer associates and existing enrollment specialists on desktop and systems procedures.
Provides notification of pregnancy, newborn, and address, changes to appropriate providers, state agencies, brokers, and clients as indicated in the business requirement.
Assists external and internal customers by responding to and resolving inquiries received via Outlook and Macess EXP related to member enrollment processes.
Uses multiple systems that include Uses Facets, EXP, Staging Tables, and Vendor systems to investigate and analyze member eligibility issues and data discrepancies. ;Trouble shoot, solve exceptions, and unusual situations.
Track and monitor incoming responses to inquiries on a daily basis. ;May provide tracking information to internal departments to facilitate information gathering for staffing purposes.
Demonstrates ability to identify trends and distinguish between routine and significant matters; identifies exceptions and provides written documentation to support decision as required.
Apprises management and IT of issues, which can positively/negatively affect services.
Reconciles audit discrepancies, corrects in the Facets system and make appropriate changes to avoid recurrence.
Maintains thorough knowledge of enrollment process systems Maintains thorough knowledge of enrollment process systems, its databases and subsystems.
Assists department and company in managing member/group enrollment inventories by meeting deadlines on a daily basis.
Handles internal requests from internal and external departments to investigate and update member enrollment information.
Meets required production and quality standards.
Consistently adheres to all established departmental and company deadlines. Participates in departmental self-audits procedures for on-going evaluation of services to ensure monthly departmental standard and met.
Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with ACFC employees and clients at all times. ;Adheres to ACFC policies and procedures; supports and carries out the company Mission and Values. ;Demonstrates and supports commitment to corporate goals and mission.
Supports the HICS Analyst(s) with eligibility research, case resolution and member reconciliation on an ongoing basis. Completes eligibility updates as required and provides a detailed accounting of all actions taken to resolve cases.
Researches returned checks and submit service requests through the vendor system to have check issues resolved.
Reviews and resolves pre and post Facets vendor discrepancies daily and ensures that all vendor discrepancies are addressed in a timely manner.
Interacts with other departments and key vendors to resolve issues.
Maintains an awareness of Affordable Care Act regulations with regard to enrollment, billing, grace periods, special enrollment periods, and open enrollment.
Performs other related duties and projects as assigned.
Education/Experience:
Associates Degree preferred.
3-5 years prior enrollment experience required.
3-5 years prior experience researching and analyzing data required.
3-5 years prior HealthCare/Managed care experience required.
Intermediate Microsoft Office Skills including Word, Excel, and Access.
Data mining and root cause analysis skills.
Excellent verbal and written skills.
Diversity, Equity, and Inclusion
At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
Apply Now