Eligibility Representative (Finance)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Eligibility Representative is responsible for the day-to-day operations regarding member eligibility and PCP assignment. As well as provide support to the Alignment Health Plan internal departments, employee/partner and contracted providers in obtaining proper member, PCP, and eligibility information. Ensure that all member discrepancies are corrected within alignment Health plan database.

General Duties/Responsibilities:

Responsible for assisting the department with month-end eligibility process. Includes ensuring that each member has a PCP assignment, updating all new and terminated members and the processing and distribution of PCP and specialty E-lists. Provides proper member eligibility to vendors, providers, and outside agencies. Provides ongoing clean-up of member data to ensure correct member information as well as ensure that the internal provider and specialty cross reference table is maintained up to date within the required data base systems. Ensures that all requests for regular and retro PCP transfers as completed by the Member Services Staff or Network Operations are completed and report all changes on a monthly basis to providers via the PCP Elist, as well as daily updates to the necessary agencies. Ensures that participation is made in the development and implementation of programs with direct effect towards the eligibility department. Participates in training programs and with the creation of materials for the day-to-day activity that is performed within the department. Meets specific deadlines. Responds to variations in daily workload by assigning task priorities according to department policies and standards. Prepares source data for computer entry by compiling and sorting information, establishing entry priorities. Maintains data entry requirements by following data program techniques and procedures. Enters customer and account data by inputting alphabetic and numeric information on keyboard or optical scanner according to screen format. Other duties as assigned

Minimum Requirements:

Job Requirements:

Experience:

• Required: Minimum of 2 experience years of Data Entry and general office background. Minimum 1 year of customer service experience. Minimum of 1 year of HMO experience.

• Preferred:

Education:

• Required: High School Diploma or GED.

• Preferred: College Degree

Training:

• Required:

• Preferred:

Specialized Skills:

• Required:

• Ability to Keyboard/type 45+ words per minute.
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
• Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
• Computer Skills: Basic skills required.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

• Preferred: Bilingual Spanish/English

Licensure:

• Required: None

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arms. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com .
Pay Range: $41,600.00 - $57,600.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com .