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QUEST Integration Membership and Enrollment Specialist II

at HMSA

Posted: 10/2/2019
Job Reference #: 5000519614406
Categories: Insurance
Keywords: claims

Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Non-exempt

Job Summary

Responsible for applying business knowledge and skills to ensure timely processing of enrollment applications and the accurate reconciliation of accounts in accordance with established standards and applicable government regulations. Perform a variety of duties related to QUEST Integration membership data file maintenance, electronic data file interfaces, and reconciliation while achieving department goals for production and accuracy. This includes but is not limited to increasing the level of automation, problem identification and resolution, improving work-flows and procedures, develop and revise appropriate documentation, and support testing needs related to membership enrollment. You will be assigned to coordinate, guide and train the team with daily production tasks, special projects and assignments of low to medium complexity. You will serve as a team player and role model for other employees in the organization by always exhibiting traits of courtesy, caring, helpfulness, and respect. You will conduct yourself in a service-oriented manner that is attentive, pleasant, cooperative, sensitive, respectful, and kind when dealing with members, visitors, the public, and all employees.

Minimum Qualifications

  1. Associate's degree and one year of related work experience; or an equivalent combination of education and related work experience.
  2. Excellent oral and written communication skills.
  3. Basic knowledge of Microsoft Office.

Duties and Responsibilities

  1. Membership Enrollment Quality Assurance:
    • Perform assignments based on established policies, procedures, practices, methods and instructions related to the membership enrollment process. Monitor, audit, evaluate and make corrections to QI membership enrollment data in a timely manner to prevent claims errors, billing discrepancies and customer service issues.
    • Gather, compute, compile, and enter membership enrollment data for statistical reports and studies, ad hoc inquiries, tracking inventory and to provide status reports for both internal and external customers.
    • Track and maintain appropriate documentation as required.
    • Communicate analysis, assessments, recommendations and completed work product through professional written and verbal reports and presentations. Conduct presentations to all levels of the organization (unit meetings, department meetings, management meetings, etc.) to ensure reporting of quality outcomes are consistent and understood.
  2. Projects and Testing:
    • Work on special projects or large volume data maintenance projects.
    • Facilitate, participate and support testing needs and requirements as the subject matter expert involving system enhancements or changes related to membership and enrollment.
    • Ensure all appropriate processes are followed and documentation is completed as required by acting as quality control checkpoint verifying standards are adhered to.
  3. Teamwork and Training & Development:
    • Coordinate implementation within department, including but not limited to assisting with the development of processing and procedure documentation, training materials and employee training as required.
    • May initiate cooperation with other staff members both within and outside the department in the accomplishment of one's own job duties as well as assisting others in accomplishing theirs.
    • Develop and initiate team building and unity.
  4. Other Duties/Functions:
    • Perform other duties and accepts responsibility as assigned.
    • Attend training as needed or assigned.