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Check with seller Enrollment Specialist II - Remote Eligible Albuquerque

Published date: April 3, 2022
  • Location: Albuquerque, New Mexico, United States

This opportunity is open to remote applicants in the United States, with the exception of the following states:

Washington, Wyoming, North Dakota, and Ohio

Job Description:
The Enrollment Specialist II is responsible for maintaining current and accurate membership records by administering contractually defined eligibility and enrollment period guidelines and processing group and member transactions. In addition, the Enrollment Specialist II must be member focused in responding to questions or issues from health plan members and stakeholders regarding insurance benefits and coverage. Responsible for the administration of all federal and state regulatory requirements relative to enrollment and eligibility. Responsible for achieving prescribed department performance standards on a consistent basis.

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days

High school diploma (or G. E. D.) plus one to three years of experience in Enrollment/Eligibility. Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff. Written communication skills as well as business writing and presentation skills are required. Requires excellent organizational skills as well as a demonstrated ability to maintain professionalism and accuracy in high pressure situations. As a department subject matter expert and informal leader, the Enrollment Specialist II must demonstrate team work, ability to effectively perform peer coaching, and professionalism. Ability to use and teach efficiency tips on office support and department specific tools, available at the desktop (example: MS Outlook, Word, Excel, Email etc.)

As an Enrollment Specialist II you will take on the role of Department Subject Matter Expert, responsible maintaining eligibility information for members as well as identifying knowledge gaps and efficiency opportunities including:

  • Processing enrollment eligibility data for all product lines
  • Understanding and administering eligibility/enrollment guidelines including waiting periods, continuation guidelines, maximum age policies, including the student certification process for specified groups.
  • Generating all required member enrollment materials
  • Coordinating the processing of member identification cards
  • Reporting status of Service Level Agreements to Enrollment Leadership and providing a recommended path forward
  • Acting as a Subject Matter Expert, Enrollment Specialist II will maintain 98% personal accuracy
  • Performing peer quality audits and provide subject matter coaching and feedback aimed at improving department quality
  • Troubleshooting and resolving member eligibility inquiries real time
  • Identifying department gaps in knowledge
  • Fielding and Resolving escalated and time sensitive issues
  • Assisting with audit preparation and document gathering
  • Representing the Enrollment department needs in projects or meetings which impact member eligibility.
  • Assists in the development of documentation of process and procedures into functional process improvements to enhance overall level of service to our customers and partners. Uses the Improvement model, identifies patterns in urgent member issues, conducts root cause analysis and reports to management team
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nince hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System
Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruuidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campus

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