Address
Form of work
SalaryBilling and Eligibility Specialist
Full-time, In Office
Rancho Cordova, CA
Position Summary
The Eligibility Specialist is a key part of the department’s successful operation. The position reports to the Director of Technical Services. The Eligibility Specialist is in daily contact with members, clients, and providers, and therefore needs to be a cheerful, competent and compassionate representative of Capitol. Attendance can also directly impact the satisfaction level of our clients and retention of our accounts.
Position Key Accountabilities
- Ensure the participant/client is serviced according to Capitol Administrators business requirements
- Process all incoming eligibility/change/termination notices within 48 hours of receipt in accordance with the clients Plan Document and within Capitol Administrators procedures.
- Inform the Supervisor or Director if turnaround time falls behind expected levels.
- Notify participant/client of any missing data.
- Prepares, maintains and files check runs, as directed
- Works with Group set up and Account Management to assure the Client will be billed appropriately
- Creates, reviews and evaluates all Client bills and assures accuracy of the bill itself
- Inform the Supervisor or Director of any disputes, which may arise with a client, and any communication from an attorney or government agency.
- Advise the Eligibility Supervisor of any computer problems in the claims processing software including any error message or the failure of the system to correctly process eligibility.
- Work closely with the COBRA department to ensure that the Claims and COBRA systems are in sync.
- Assists as needed or directed with all departments.
- Participate as a Team Member to ensure the smooth operation of the entire department.
- Comply with company policies and procedures as outlined in the Employee Handbook.
- Comply with department policies and procedures.
- Assist in training other employees at management’s request.
- Perform special projects at the request of your Supervisor and Directors
- Answer all correspondence promptly and maintain correspondence files.
Attributes and Skills to assure success:
- Proficient in the use of Trizetto/RIMS eligibility programs, PBM software and desktop computer software to include word processing and excel.
- Excellent communication via written, telephonic and personal skills
- Detailed and well organized.
- Completion of all responsibilities in a timely manner
- Ability to manage and follow through consistently and accurately
- Company loyalty
