The Coordinator Membership Sr. coordinates with Commercial, Medicare and Medicaid eligibility and member maintenance transactions. The Coordinator Membership Sr. will play a critical role in processing electronic and paper enrollment transactions, as well as other correspondence that supports accurate eligibility while performing in a supervisory and subject matter expert capacity while ensuring the departmentâs business rules, contracts, industry regulations, Medicare/Medicaid guidelines, and company policies and procedure are followed. The Coordinator Membership Sr. partners with various operational business units, while supporting departmental objectives within company and regulatory guidelines. The Coordinator Membership Sr. with limited supervision, coordinates all aspects of enrollment transactions and activities to ensure accurate and timely processing of data. The Coordinator Membership Sr. identifies opportunities for process improvement and provide recommendations/solutions to the Enrollment Leadership Team. The Coordinator Membership Sr. trains new staff in all areas as needed and provide source of knowledge for staff inquiries. The Coordinator Membership Sr. provides coaching and mentoring to staff on opportunities for improvement with minimal supervision. The Coordinator Membership Sr. prepares and distribute required reports including but not limited to daily, weekly and monthly production and audit reports. The Coordinator Membership Sr. reviews daily audit trail reports, audits new and renewal group entries, enrollment processing, and reconciliations, then reports audit(s) to management. The Coordinator Membership Sr. functions as a subject matter expert in support of other Enrollment team members and other departments/facilities within the BSWH Health network. The Coordinator Membership Sr. provides back-up support to Enrollment processing as needed to maintain SLAs. The Coordinator Membership Sr. provides continuous updates and information to the Enrollment Leadership Team regarding daily inventory, ongoing errors, enrollment related issues/trends, and other controllable QA related activities affecting productivity. The Coordinator Membership Sr. performs business user acceptance testing for newly implemented software and/or processes, document results, and communicates results to the Enrollment Leadership Team. The Coordinator Membership Sr. complies with all guidelines set forth by regulatory agencies, where applicable, and defined in the Scott & White Health Plans and department policies.
The ideal candidate for the Coordinator Membership Sr. will have the ability to prioritize daily tasks and queued work items, manage turnaround times, and manage items that need escalation. The ideal candidate for the Coordinator Membership Sr. will demonstrate the ability to understand and navigate multiple health plan systems. The ideal candidate for the Coordinator Membership Sr. will have previous experience producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization. The ideal candidate for the Coordinator Membership Sr. will have customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the company. The ideal candidate for the Coordinator Membership Sr. will also have independent decision-making skills with the ability to investigate and select the course of action that provides the greatest benefit to the organization.
Location/Facility â Health Plan - Temple
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Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
PTO accrual beginning Day 1
*Note: Benefits may vary based upon position type and/or level.
3+ years of experience
Internal Number: 19006071
About Baylor Scott & White Health
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!