Enrollment Specialist (Remote)
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![]() United States, North Carolina | |
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LOCATION:
Remote -This is a home based, virtual position that operates on US Eastern Standard Time within the hours of 8:30am-5:00pm. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.
GENERAL STATEMENT OF JOB This position will ensure that all client data and benefit plan information is correct and properly submitted to Vaya Health from providers; enroll consumers into the state benefit plan when requested and appropriate. This position coordinates with the Claims Department around denials related to eligibility of consumers and works with the Access Team on eligibility and enrollment issues. This position will process both provider and auto-generated discharges. Processing of customer service update requests will also be managed with this position. The NCSNAPS database will be managed with coordination between providers and other Vaya departments. Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health. ESSENTIAL JOB FUNCTIONS Eligibility & Enrollment Data Entry, Review and Correction: This position will ensure that all client data and benefit plan information is properly submitted to Vaya from the providers and the state's NC Tracks Database. This position will review and manage discharges, Client Update Requests, Enrollments and NCSNAPS information. This position will interact with providers and internal units in a professional manner as evidenced by no complaints or grievances and through supervisor's observation. Collaboration with other Vaya Departments: This position will coordinate with the Claims Department around claim denials related to eligibility of a consumers, and work with the Vaya Access Team on eligibility issues and enrollment issues. Other duties as assigned. KNOWLEDGE, SKILL & ABILITIES This position is required to have extensive knowledge of multiple systems used by NC DHHS, including but not limited to NC Tracks and the states Consumer Data Warehouse (CDW) or any alternate systems deemed applicable by NC DHHS. Staff must be proficient with requirements related to data component formats, submission reports and processes and compliance. Proficiency with data management software is also crucial in order to assure competent completion of assigned tasks. Strong attention to detail and data accuracy is also required for this position. QUALIFICATIONS & EDUCATION REQUIREMENTS High school diploma or GED with at least 2 years' experience with Medicaid, Medicare and other 3rd party payment sources. Prior experience with member enrollment and customer service in an MCO and/or experience in the mental health field are highly desired due to the complexity of the work of the organization. PHYSICAL REQUIREMENTS:
RESIDENCY REQUIREMENT: Must live in NC, SC, GA, TN, VA, MD, or FL.
APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/. Vaya Health is an equal opportunity employer. |