Eligibility Representative (Finance)
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Eligibility Representative is responsible for the day-to-day operations regarding member eligibility and PCP assignment. As well as provide support to the Alignment Health Plan internal departments, employee/partner and contracted providers in obtaining proper member, PCP, and eligibility information. Ensure that all member discrepancies are corrected within alignment Health plan database.
General Duties/Responsibilities: (May include but are not limited to)
1. Responsible for assisting the Department Lead with ALIGNMENT's month-end eligibility process. This includes ensuring that each member has a PCP assignment, updating all new and terminated members and the processing and distribution of PCP and specialty E-lists.
2. Ongoing clean up of member data to ensure correct member information as well as ensure that the internal provider and specialty cross reference table is maintained up to date within the required data base systems.
3. Ensure that all requests for regular and retro PCP transfers as completed by the Member Services Staff are completed and report all changes on a monthly basis to Alignment Health plan providers via the PCP Elist, as well as daily updates to the necessary agencies.
4. Assist the Department Lead in the daily process of all member regular and retro dis-enrollments as reported by CMS or the Membership Department. Ensure that the proper capitation is deducted or applied.
5. Report on a monthly basis the date of Elist and capitation distribution to ALIGNMENT's medical groups and or management companies.
6. Monthly maintenance, submission and reporting of all retro-capitation due to PCP's to Alignment Health plan Finance Department. This includes all MNF's (Member Not Found) sheets forwarded to the department by the Utilization Management Department. Recognizes work related problems and contributes to solutions.
7. Will provide back-up to receptionist coverage for lunch and break periods when necessary. This also includes greeting and assisting patients, visitors and other staff.
8. Will ensure that participation is made in the development and implementation of programs with direct effect towards the eligibility department. Participate in training programs and with the creation of materials for the day-to-day activity that is performed within the department.
9. Will assist the Department Manager in maintaining office supplies at a level necessary for proper functioning of the department.
10. Shall perform all clerical duties deemed necessary to ensure smooth functioning of the department and as directed by Department Manager, assist other personnel as needed and as time permits.
11. Meet specific deadlines. Responds to variations in daily workload by assigning task priorities according to Department policies and standards.
Pay Range: $41,600.00 - $57,600.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com .
