Job description
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Responsibilities:
Under the direction of the ACA Operations Manager, the Health Insurance Casework System Analyst is responsible to receive, triage and resolve Health Insurance Casework System (HICS) cases adhering to all CMS Federally Facilitated Marketplace Guidelines:
- Research, follow up and resolve discrepancies associated with membership eligibility.
- Analyze member eligibility and take appropriate actions to resolve issues across all systems.
- Oversee, analyze and provide feedback to all areas that participate in HICS case resolution.
- Develop, implement and execute HICS training to business areas as needed.
- Analyze and evaluate operations to identify and suggest process improvement.
- Monitor and track HICS data.
- Identify irregular trends with HICS cases; work with other areas as appropriate to identify root causes and take appropriate steps for resolution.
- Document and report data to appropriate internal committees.
- Make outbound phone calls in support of the HICS processes.
- Must expertly understand, navigate and comply with federal regulations pertaining to written notification/letters as outlined CMS Federally Facilitated Marketplace Guidelines.
- Strong knowledge of the enrollment reconciliation report process for the enrollment vendor and CMS.
- Perform any other job related instructions as requested.
Education/ Experience:
- Knowledge of HIPAA regulations and healthcare administration functions, including claims processing, eligibility verification, provider verification and preauthorization desirable.
- Proficient in MS office.
- Strong skills in Access and Excel to extract and analyze data, and create dashboards for reporting.
- Experience working with large data sets.
- Excellent communication skills.
- One to three (1 to 3) years of experience.
- High School/GED.
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