Elig & Enrollment Specialist

Where Compassion Meets Innovation And Technology And Our Employees Are Family

Thank you for your interest in joining our team! Please review the job information below.

General Purpose Of Job : The Eligibility and Enrollment Specialist is responsible for receiving, reviewing, processing, and maintaining new member(s) enrollment information. The Eligibility and Enrollment Specialist is responsible for monitoring and working to ensure that member eligibility and enrollment requirements are in compliance with Health Human Services Commission (HHSC) contractual requirements and Utilization Review Accreditation Commission (URAC) standards.

Essential Duties And Responsibilities : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and / or health plan administration, as required.

General Duties :

• Maintains utmost level of confidentiality at all times.
• Adheres to Health System and Health Plan policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Performs all other tasks as assigned by upper management.
• Adheres to department policies, procedures and guidelines.

Education And / Or Experience : Any combination of education and experience that would likely provide the required knowledge, skills, and abilities is qualifying.