Full-Time Enrollment and Reconciliation Specialist
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Job Description
THE COMPANY
AlohaCare is a local, non-profit health plan which provides comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. In the true spirit of Aloha, AlohaCare supports, cares and serves the health care needs of Hawaii’s residents and specializes in care for the medically underserved and medically fragile. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
THE CULTURE
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare’s strong commitment to support local Hawaiian families is practiced with our employees by reinforcing a healthy work/home balance. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, monthly appreciation events, quarterly all-staff meetings and annual galas. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
PRIMARY RESPONSIBILITIES
Position Summary:
Responsible for the timely quality analysis of AlohaCare’s enrollment data through the review of eligibility files, enrollment applications, and reports to ensure integrity of member records.
Primary Responsibilities:
Ensures accuracy and compliance of all enrollment/disenrollment transactions, member notifications, maintenance transactions, and automated processes.
Generates necessary reports from various external system applications to perform enrollment functions and maintains any record tracking files as necessary. Utilizes same report(s) as a key component of the reconciliation process by comparing report data against QNXT enrollment records.
Quest Newborn research, tracking and reporting to ensure newborns are enrolled with the correct Quest plan.
TPL (Third Party Liability) research, tracking and updates to ensure members with other primary coverage are correctly updated in AlohaCare systems for proper claims payments. This will include outbound phone calls and faxing to other insurance carriers.
Ensures State and CMS enrollment, disenrollment, and maintenance transactions are processed with accuracy and in compliance with all applicable regulations through file auditing.
Adheres to all audit and compliance policies established by CMS, DHS, AlohaCare and all other governing entities. Maintains supportive enrollment documentation accordingly.
Maintains the integrity of the database through timely and accurate updates, additions, and deletions of membership records.
Researches and responds to enrollment and/or eligibility-related inquiries from internal and/or external customers.
Generates and tracks plan-to-member communications and notifications in accordance with CMS/DHS guidelines.
Monitors daily activities and transactions to ensure compliance with AC and government regulatory requirements.
Develops and maintains department documentation such as policy and procedures, workflows and training materials.
Other duties as assigned.
Required Competencies & Skills:
Requires operation of general office equipment to include; PC, fax/copy machine and ACD Midel Phones.
Intermediate skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
Detail oriented, accurate data entry and possess strong organizational and analytical skills.
Work independently by prioritizing duties, coordinating projects to meet deadlines, and taking initiative.
Available to work a flexible schedule, including weekends and holidays, when necessary.
Preferred Qualifications:
Prior experience with Medicare and/or Medicaid.
Prior experience with QNXT.
Prior experience in the health insurance field.
Demonstrate ability to perform highly advanced research; skills in problem identification and resolution.
Previous experience documenting internal processes and workflows.
Working Conditions/Physical Demands:
Inside working conditions.
No environmental hazards.
Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record), disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.
How to Apply:
For more information, please contact Josie Gesteuyala, HR Generalist
Phone: 808.973.6339
Email: jgesteuyala@alohacare.org
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