Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: The Eligibility Coordinator provides support to the Health Choice Member Outreach Department by performing various clerical functions and maintain organized and effective procedures to support the department (including but not limited to):
- Adhere to HIPAA laws at all times; notify Privacy Officer immediately upon learning of a real or potential breach of protected health information.
- Process eligibility updated/ PCP changes / Open Panel Requests (MS, Providers, finance, IT, Network)
- Work with IT to ensure eligibility is transmitting correctly to our vendors (PBM, Transportation, Card vendor, etc.)
- Interface with outside agencies to report or verify eligibility and update as necessary (UDOH, CMS, PMMIS, AHCCCS on line and PBM)
- Prioritize work flow to maintain an efficient process of completing the assignments daily
- Various error reporting (Pharmacy Report, Encounter Report, Daily Report, Finance Report, etc.)
- Maintain Eligibility Mailbox (Processing incoming request, respond to inquiries from other departments, Materials Request, Claims History Request, etc.)
- HIPAA / Discharges
- Serve as back-up phone coverage for the Contact Center in adherence to department benchmarks and performance measures.
- Serve as back-up for Retention outbound projects as necessary.
Education / Experience / Other Requirements
- High School Diploma or equivalent GED preferred
Years of Experience:
- At least one (1) year of customer service experience preferred
- At least one (1) year of call center environment preferred
- Active listening skills, highly empathetic, conflict resolution skills
- Excellent verbal and written communication skills
- Proficient computer skills, typing, and multi-systems navigation
- Advanced Knowledge of Microsoft Office: Word, Excel
- Effective time management, organizational, and communication skills
- Bilingual (Spanish speaking competency) is a plus