Elig & Enrollment Specialist

Driscollchildrens

Not specified
Health insurance managed care principles
Microsoft excel and word proficiency
Hhsc contractual requirements compliance
The Eligibility and Enrollment Specialist position at Driscoll Children's Health System involves managing member enrollment information and ensuring compliance with health regulations. The role requires attention to detail, analytical skills, and effective communication to navigate eligibility and enrollment processes

Job Summary

  • The Eligibility and Enrollment Specialist is responsible for receiving, reviewing, processing, and maintaining new member enrollment information while ensuring compliance with Health Human Services Commission and URAC standards.
  • Employees are expected to maintain the utmost level of confidentiality and adhere to corporate compliance and integrity guidelines at all times.
  • The role involves performing tasks such as monthly file error correction, PCP assignment, coverage creation, and resolving pharmacy issues under supervision or minimal supervision depending on the level.

Matching Summary

Match Score: 75

The Eligibility and Enrollment Specialist position at Driscoll Children's Health System involves managing member enrollment information and ensuring compliance with health regulations. The role requires attention to detail, analytical skills, and effective communication to navigate eligibility and enrollment processes.

Skills & Requirements

Must-have

  • Health insurance managed care principles
  • Microsoft Excel and Word proficiency
  • HHSC contractual requirements compliance
  • URAC standards adherence
  • Eligibility and enrollment verification

Nice-to-have

  • Ability to work independently in team environment
  • Strong analytical skills for data trends
  • Experience with newborn enrollment processes
  • Effective communication with co-workers
  • Integrity and discretion with confidential data

Key Requirements

  • Two-year degree or Associate's degree
  • 1 year related experience for Level I
  • 5 years related experience for Level II
  • High School Diploma equivalent combination
  • Experience with health insurance principles

Work Rights

Not specified

Tailored Resume

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