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Enrollment Specialist

Mercy Health Corporation
vision insurance, paid time off, retirement plan
United States, Wisconsin, Janesville
Jan 18, 2025
Overview

Responsible for the membership enrollment area for all lines of business and MercyCare products. Will handle day-to-day member enrollment data entry, maintenance processes and functions using managed care software. Process, maintain and problem resolution of electronic enrollment files. Organizes and maintains materials for customized benefit packages for all insurance products. Responsible for the member identification card process and materials for all products. Responds to all internal and external customer inquiries regarding enrollments and plan documents. Management of Enrollment work queues to review or correct records for timely processing. Membership downloads from secure sites for groups, including monthly file compare and maintenance. Maintains a variety of guides, visuals, handouts, or training documents for the purpose of providing current reference materials to comply with established guidelines. To perform this job successfully, an individual should have knowledge of membership and group enrollment processing systems; Spreadsheet software and Word processing software. Successfully able to fulfil all responsibilities of the Enrollment Representative 1 and Enrollment Representative 2 roles Able to work with minimal supervision and performs other duties as assigned.
Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Creates alternatives and identifies key requirements to assist with process improvements and workflows

  • Problem investigation ranging from moderate to complex situations or data requires detailed review of factors and issues between departments and outside contacts

  • Follow policies and procedures and adapt to changes

  • Demonstrate accuracy and thoroughness and improve and promote performance quality

  • Responds promptly to requests and assistance and maintains confidentiality and respect

  • Skillfully identify and resolve problems in a timely manner

  • Demonstrate persistence and overcome unexpected obstacles

  • Display willingness to make and follow through with decisions

  • Ability to write routine reports, correspondence and participate in the development of formal policies and procedures

  • Assists with training and mentor's enrollment staff

  • Review and process of adult dependent verification

  • Coordination of Benefits (COB) processing and maintenance

  • Coverage review and maintenance related to pharmacy, retiree and Medicare

  • Review and maintenance of coverage records for Medicaid encounter data and capitation reports

  • May be responsible for correction of highly complex enrollment issues and system set-up

  • Research coverages of insurance companies through phone, web, or contracts

  • Provides feedback or updates to the supervisor on a regular basis

  • Analyze enrollment or coverage related issues to investigate root cause.

  • Assists in the development of ongoing trainings for Enrollment staff to ensure compliance with consistency, uniformity and understanding of the enrollment process and the downstream effects.

CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by Mercyhealth confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

EDUCATION & EXPERIENCE

High School Diploma or equivalent. A minimum of 5 years of experience in enrollment processing in a managed care environment. Prior knowledge of computer spreadsheet and word processing applications preferred.

ADDITIONAL REQUIREMENTS

Passing the Driver's License Check and/or Credit Check (for those positions requiring).

Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.

Must be able to follow written/oral instructions.

OTHER SKILLS AND ABILITIES

Excellent telephone and oral communication skills. Excellent, thorough and accurate data entry skills.

Language Skills

Ability to read, analyze and interpret general business periodicals, professional journals, technical

procedures, or governmental regulations. Ability to write reports, business correspondences and

procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Speaks clearly and professionally in positive or negative situations; Listens and gets clarification; Participates in meetings.

Mathematical Skills

Basic math skills and problem solving.

Computer Skills

To perform this job successfully, and individual should have knowledge of membership and group

enrollment processing systems; Spreadsheet software and Word processing software.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

WORK ENVIRONMENT

The noise level in the work environment is usually quiet.

Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure.

INFORMATION ACCESS

Partner may access patient care information, financial data, human resource data and strategic and planning data needed to perform their job duties as directed by the director.

WORK CONTACT GROUP

Position requires frequent communication with employer group contacts, carriers, agents, and members as well as, all levels of Mercy Health System personnel.

SPECIAL PHYSICAL DEMANDS

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl. The employee is frequently required to sit and work at a computer for long periods of time up to 10 hours daily. The employee is occasionally required to stand for long periods of time. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. The employee must be able to hear at high and low levels through voice and telephone communications to be able to respond to patients and partners.

While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard. Requires exerting 25 to 50 pounds of force occasionally, and lift up to 10 to 15 pounds frequently.

LEVEL OF SUPERVISION

Some independent judgment is required, alternatives are limited by standard practices or procedures. Assignments are normally received in the form of results expected and due dates. General procedures are available to guide work responsibilities.


Benefits

Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to:

* Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.

* Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.

* Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.

* Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.

* Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.

* Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.

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