MA Enrollment Rep I (Level I)
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Purpose of the Job
Reviews and reconciles accounts receivables, enrollment and eligibiity processing and inbound customer service calls on large group employer accounts.
Essential Job Functions & Responsibilities
• Process applications received in various formats within established time-frames to adhere to CMS guidelines.
• Identify, research, process, resolve and respond to customer as it relates to incomplete applications
• Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
• Document and record facts in regard to inquiries and correspondence by updating BCBSAZ files and system
• Perform demographic maintenance received from various sources
• Monitor and review notifications generated from erred electronic files
• Review and process disenrollment request
• Resolve billing and eligibility discrepancies and communicate with customer as appropriate
• Reconcile monthly payments received, identify out of balance conditions and when a refund in necessary
• Reconcile daily TRR file from CMS and ensure appropriate letter is scheduled
• Monitor, process and resolve timers such as out of area, late enrollment penalty and pending applications
• Mentor and train level 1 employees
• Reconcile monthly membership report as well as the prescription drug edit report
• Submit monthly enrollment data validation
• Process late enrollment penalty appeal response from Maximus
• Perform model office testing on system enhancements and projects
• Mentor and train level 1 and 2 employees
LEVEL 4 – Performs functions in a lead capacity
• Perform standard comparison reporting to identify discrepancies between systems
• Update and review any department documentation
• Coach and mentor as errors are identified through the auditing process
• Consult and coordinate with various entities to obtain information and ensure resolution of customer inquiries or retro-request.
• Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedure, forms and manuals.
• Train employees on multiple functions
• Each progressive level includes the ability to perform the essential functions of any lower levels.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Skills / Requirements
1. Required Work Experience
• 2 year(s) of experience in accounting field (Applies to All Levels)
2. Required Education
• High-School Diploma or GED in general field of study (Applies to All Levels)
3. Required Licenses
4. Required Certifications
• 4 year(s) of experience in accounting field (Applies to Levels 2 - 3)
• 1 year of supervisory or lead experience (Applies to Level 4)
• 1 year of experience as a Membership and Billing Rep III (Applies to Level 4)
1. Required Job Skills
• Intermediate skill in use of office equipment, including copies, fax machines, scanner and telephones (All Levels)
• Intermediate PC proficiency (Applies to All Levels)
• Intermediate proficiency in spreadsheet, database and word processing software (Applies to All Levels)
• Type >35 words per minute with 5% error rate or less (Applies to All Levels)
• Ability to work with groups with 5,000+ members (Applies to Level 4)
2. Required Professional Competencies
• Maintain confidentiality and privacy (Applies to All Levels)
• Practice interpersonal and active listening to achieve high customer satisfaction (Applies to All Levels)
• Interpret and translate policies, procedures, programs and guidelines (Applies to All Levels)
• Capable of investigative and analytical research (Applies to All Levels)
• Navigate, gather, input and maintain data records in multiple system applications. (Applies to All Levels)
• Establish and maintain working relationships in a colaborative team environment (Applies to All Levels)
• Prioritize, organize and self-manage workload in a hgh volume department (Applies to All Levels)
3. Required Leadership Experience and Competencies
1. Preferred Job Skills
• Advanced knowledge of accounting practices (Applies to Levels 2 - 3)
2. Preferred Professional Competencies
• Knowledge of a wide range of matters pertaining to the organization's operations (Applies to All Levels)
3. Preferred Leadership Experience and Competencies