Eligibility Analyst

Job Title: Eligibility Analyst

Summary/Objective: The Eligibility Analyst provide daily support and processing of eligibility related functions for all Compass Health Administrator clients while maintaining integrity and superior customer service as it relates to eligibility and COBRA functions for clients and members in a timely and accurate manner. This person will also provide exceptional support to other departments through collaboration and an unwavering desire to please the customer.

Supervision Received: Manager, Billing & Eligibility

Essential Functions:

ADMINISTRATIVE FUNCTIONS

1. Eligibility Administration

2. Responsible for interactions with clients and vendors to resolve eligibility discrepancies

3. Responsible for the timely and accurate processing of eligibility administration to ensure that regulatory requirements are met, clients are satisfied and retained and plans are administered in accordance with plan documents

4. Reviews, processes, and maintains basic member data for enrollments, including COBRA eligibility and enrollment.

5. Issue ID cards and import/export eligibility information from database

6. Manage COBRA system and eligibility including generating required COBRA and HIPAA notifications, enrolling and handling of COBRA continuation paperwork

7. Supports other departments and staff in providing accurate eligibility information and data research.

8. Provide reporting documents, system testing and other functions as required by clients and internal departments

9. Provides ongoing feedback to help optimize quality performance.

10. Collaborates with others and cross-departmentally to improve or streamline procedures.

11. Develops new or improves current internal processes to improve quality

MANAGEMENT FUNCTIONS – Currently not a supervisory role, however as the department and organization grow, the management functions could include:

§ Aligns people and projects to achieve initiatives.

§ Works with direct reports to develop goals and objectives.

§ Works with direct reports to establish performance standards for work assignments, monitors work

§ status and progress including goals and objectives.

§ Values cultural diversity and other individual differences in the workforce, ensuring that the

§ organization builds on these differences.

§ Develops staff through coaching, mentoring, rewarding, training, and guiding. Empowers employees

§ and recognizes and rewards their contributions.

§ Manages employee issues and resolves grievances.

§ Completes performance evaluations for direct reports on a timely basis.

§ Assists all staff in the interpretation of policies and procedures.

§ Assesses current and future staffing needs based on organizational goals.

BUSINESS FUNCTIONS

§ Maintains a current understanding of all Eligibility and COBRA requirements including regulatory and compliance changes or updates

§ Provide valuable input into development and facilitation of processes related to eligibility and COBRA in a customer service environment

§ Supports and implements organizational technology changes.

§ Ensures quality of work performed by direct reports in area(s) of responsibility.

§ Commits to a focus on continuous improvement of workflow processes and procedures.

§ Actively participate in meetings and corporate events

§ Performs other related duties and responsibilities as directed

Required Education/Experience:

2 years experience in healthcare administration, customer service, claims processing with eligibility and COBRA regulations and procedures specific experience preferred.

Additional Eligibility Qualifications

Demonstrated experience in overall process management. Possess personal qualities of integrity, credibility, and commitment to corporate mission.

Flexible and able to multitask; can work within an ambiguous, fast-moving environment, while also driving toward clarity and solutions; demonstrated resourcefulness in setting priorities and guiding investment in people and systems.

Environmental/Work Conditions: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand; walk; and reach with hands and arms.

Job Type: Full-time

Pay: $23.00 - $28.00 per hour

Benefits:

• 401(k) matching
• AD&D insurance
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Vision insurance

Application Question(s):

• Do you have any experience with COBRA administration?
• Do you have any experience working in benefit administration, Third Party Administration, or eligibility?

Ability to Commute:

• Fresno, CA 93720 (Required)

Work Location: In person