Supervisor Eligibility en Leading Edge Administrators LLC

Description

Job Summary: 

The Supervisor of Eligibility will provide employees with leadership, training, and development for the team responsible for the enrollment and maintenance of membership records related to qualifications for coverage under contacts or agreements. This role will lead a team and guide the development of knowledge of products, benefits, quality requirements and organization procedures as well as resolve issues. This Supervisor of Eligibility will coordinate both internally and externally by providing information and reporting. 

Duties and Responsibilities:

• Prepare, analyze and monitor eligibility reconciliation to ensure that all exceptions and rejected data have been researched and updated 
• Provide direction to team on issues/questions relating to eligibility and enrollment programs and tools 
• Manage the eligibility processes to maximize operational goals and objectives, including identification and implementation of opportunities for automation 
• Create, edit, and clearly communicate documentation that serves as a resource and reference material. Disseminate all updates. 
• Ensure staff understanding and application of local, state and federal laws and guidelines related to benefits 
• Identify and monitor key performance indicators to meet quality, time, service, and productivity goals. 
• Provide robust reports to track enrollment and respond to ad hoc requests for data
• Create and monitor standard reports to identify issues and/or trends impacting performance; take action to identify root cause and pursue remedies
• Conduct and review audits and analyses on completed member data load processes and monitor eligibility loads, data updates and all internal/external requests. Identify and analyze trends in data, review error reports, and process discrepancies
• Deliver functional training to team and clients
• Conduct effective resource planning to maximize productivity and turn-around time
• Conduct feedback sessions with a regular cadence to review metrics, performance and quality of team members; identify successes and opportunities
• Motivate and encourage direct reports through positive communication and feedback. Coach and correct as needed.

Requirements

Required Knowledge, Skills, and Abilities:

Associate degree in a field related to managing enrollment in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience; bachelor degree or equivalent experience preferred

• 3+ years of experience in a supervisory role in a healthcare member enrollment/eligibility setting where HIPAA and HITECH standards are utilized, preferably in a healthcare TPA
• Experience with benefit administration platforms such as Javelina preferred
• Strong working knowledge of the HIPAA ANSI 834 5010
• Knowledge of Cobra administration preferred
• Working familiarity with self-funded and Section 125 eligibility rules
• Solid working knowledge of standard computer applications including MS Word, Excel Outlook, and PowerPoint
• Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful. Demonstrate collaborative interaction with peers to reach a common goal.
• Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment 
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyzes information skillfully
• Teach, coach, and counsel associates by effectively communicating and providing follow-up.
• Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers

Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus 
• Occasional: Lift and/or move up to 30-50 pounds
• Constant: Regular, predictable attendance is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending. 

Work Environment - The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.  

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.