What You’ll Be Doing

• Prioritize the monthly Eligibility process based on capitation and claims processing
• Input and maintain returned eligibility forms and documents on a daily basis
• Generate member notification letters
• Track website inquiries and urgent additions from other departments
• Responsible to work the eligibility appeals forwarded by other departments
• Responsible to work on a monthly, daily and weekly audit reports
• Contact Home Plan for clarification of eligibility
• Build and maintain group files, coordinate benefit plan updates and additions with the Auditing and System Compliance Operations team
• Assist with maintaining the PCP auto assignment process through Access reporting based on geographical areas and updating the member’s eligibility file
• Assist with downloading on a weekly basis the OPX files from the Home plan and flag the member’s eligibility files as indicated, communications to the claims department regarding the OPX status
• Assist with maintaining members with the exchange product that are under the APTC status and their grace periods
• Assist with writing and maintain eligibility workflow documents and training material
• Stay current on federal and state eligibility requirements
• Work with Eligibility Lead to automate processes and build new reporting
• Other duties and responsibilities as assigned

What You’ll Bring

• Minimum 2-3 years of experience in the healthcare or managed care industry, primarily in the eligibility role with an understanding of Coordination of Benefits rules
• Advanced proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access
• Successfully function as an Eligibility Specialist
• Ability to work independently with minimal supervision and as part of a team
• Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data
• Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player
• Demonstrates the ability to multi-task with minimal supervision and the ability to prioritize appropriately
• Able to problem solve, exercise initiative and make low to medium level decisions
• Basic understanding of current federal, state and local healthcare compliance requirements
• Effective written and oral communication

Would Love For You To Have

• Experience and knowledge with Medicare Advantage strongly encouraged

What You’ll Get

• Learn the life of a Contract Management firm with Independent Physician Associations across Illinois.
• Encouragement to bring ideas to the table.
• Be part of a desired team within Arcadia’s Value Based Services.
• Opportunity to be part of a team creating automated processes to drastically improve healthcare.
• Extraordinary and flexible work environment and culture.
• Competitive compensation.
• Amazing benefits package including flexible time off.
• Receive cash compensation with health, dental, and other benefits
• A flexible, remote friendly company with personality and heart
• Employee driven programs and initiatives for personal and professional development
• Be a member of the Arcadian and Barkadian Community